The experts said that less than 15 percent of patients felt an improvement in pain and function three months after arthroscopic surgery.
A panel of international health experts and patients has challenged the effectiveness of one of the most common orthopedic procedures and recommended strongly against the use of arthroscopic surgery for patients with degenerative knee problems.
The guidelines, published Wednesday in the journal BMJ, relied on 13 studies involving nearly 1,700 patients that found the surgery did not provide lasting pain relief or improve function. Those studies compared the surgery to a variety of options, including physical therapy, exercise and even placebo surgery.
The experts said that less than 15 percent of patients felt an improvement in pain and function three months after the procedure, and that those effects disappeared after one year. In addition, the surgery exposed patients to “rare but important harms,” such as infection.
Casey Quinlan, 64, who had the surgery in 2003 and was on the panel issuing the guidelines, said her orthopedist told her the procedure would not only help restore mobility in her knee after a nasty ski accident but also improve her arthritis.
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Quinlan, of Richmond, Virginia, said the procedure did not deliver and her arthritis remained unchanged. “It was not what I was told to expect,” she said.
In an arthroscopic knee surgery, physicians make several small incisions around the joint and insert a tiny camera that allows them to see inside the knee as well as insert small instruments to correct problems they identify. Often the surgery is performed to remove part of a damaged meniscus, a disc of cartilage that helps cushion the knee.
The panel said meniscal tears “are common, usually incidental findings, and unlikely to be the cause of knee pain, aching or stiffness.”
The panel said the surgery is performed more than 2 million times a year across the globe, and in the United States alone costs more than $3 billion annually.
The panel’s recommendations are counter to guidelines from a number of medical groups. Most of those organizations have recommendations against arthroscopy for patients solely with arthritis that can be seen through an X-ray. But many still promote the procedure for people with ailments such as meniscal tears, which are frequently present in arthritic patients.
The American Academy of Orthopaedic Surgeons (AAOS) does not recommend the treatment for patients with arthritis, said David Jevsevar, chair of the AAOS Council on Research and Quality. He said the BMJ assessment is in line with current evidence, but he also cautioned that generalizing a variety of randomized trials does not necessarily take into account the circumstances of individual patients.
“Guidelines don’t apply to every patient,” he said. “There’s always going to be an exception.”