Study: Knee Surgery Doesn't Work

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Study: Knee Surgery Doesn't Work

Thu Jul 11,12:14 AM ET

By LINDA A. JOHNSON, Associated Press Writer

A type of knee surgery performed on more than 300,000 Americans each year

to ease arthritis pain is

worthless and perhaps even harmful, government researchers say.

The study looked at arthroscopic knee surgery for osteoarthritis, the

painful, steadily worsening, wear

and tear on joints that affects 12 percent of senior citizens. The

operation is done to clear out debris or

repair damaged cartilage.

In a type of study only rarely conducted, some patients got a real knee

operation, while others

underwent sham surgery.

At every point over the next two years, those who had the fake surgery

could climb stairs and walk

slightly faster on average than those who had gotten real operations.

In arthroscopic surgery, a flexible viewing tube called an arthroscope

lets the surgeon see inside a joint.

Only tiny incisions are needed, and patients heal quickly.

Arthroscopic knee surgery for osteoarthritis costs roughly $5,000, or a

total of $1.5 billion a year in

the United States, said Dr. Nelda Wray, a researcher at the Houston VA

Medical Center who led the

study.

" We think that money could be better spent, " she said.

The findings could prompt insurance companies to refuse to pay for the

procedure. Other treatments

for arthritic knees include pain relievers, cortisone shots, hot packs,

exercise and, as a last resort,

knee-replacement surgery.

Dr. W. Tipton Jr., executive vice president of the American

Academy of Orthopedic

Surgeons, said other researchers should duplicate the results before

doctors, patients and insurance

companies react. But he said the study confirms some doctors' growing

suspicions.

He said many orthopedic surgeons already feel that arthroscopic surgery

should not be used except in

certain circumstances, such as acute sports injuries to ligaments. Tipton

added that he has arthritis but

is opting for knee replacement surgery.

The study was published in Thursday's New England Journal of Medicine (

news - web sites).

Surgical procedures are often not subjected to the kind of rigorous

testing done on medications. Some

critics consider sham surgery unethical because of the risk of harm to

study volunteers.

But Sam Horng and lin G. of the National Institutes of Health

( news - web sites) said in

an accompanying editorial that the VA study " exemplifies the ethically

justified use of placebo surgery. "

In the study, 180 veterans 75 or younger were divided into three groups

for arthroscopic surgery at the

medical center, all done by the same expert surgeon between 1995 and 1998.

One-third had arthroscopic debridement, in which debris and rough and torn

pieces of cartilage are

removed or sanded down. Another third had arthroscopic lavage, in which

debris and calcium

phosphate crystals are flushed out. The remaining third likewise were

anesthetized and had three

incisions made in the knee, but the surgeon only manipulated the knee as

if working on it.

No one knew which procedure they had for two years, during which they

received regular evaluations.

During that period, all three groups said they had slightly less pain and

better knee movement, with the

sham-surgery group often reporting the best results. That apparently

reflects the well-known " placebo

effect, " in which patients feel better simply because they believe they

have been treated.

However, tests in which the patients were timed as they walked and climbed

up and down stairs found

that patients in the two treatment groups were slower than they were

before surgery.

For much of the study, patients in the sham-surgery group were faster than

they were before the

operation. By the end of the two years, though, they were about the same

as they were before the

sham surgery, because their knees continued to deteriorate.

Dr. Todd P. Stitik, associate professor of rehabilitation at University of

Medicine and Dentistry of New

Jersey in Newark, said patients he has sent for arthroscopic surgery were

not helped much.

" I don't think this is now necessarily a reasonable option, " he said.

He said his patients have benefited more from a relatively new treatment -

injections of a synthetic

version of fluid inside the knee that acts as a

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[Guest guest]

Very interesting indeed, Heidi!

[ ] Study: Knee Surgery Doesn't Work

> Study: Knee Surgery Doesn't Work

> Thu Jul 11,12:14 AM ET

>

> By LINDA A. JOHNSON, Associated Press Writer

>

> A type of knee surgery performed on more than 300,000 Americans each

year

> to ease arthritis pain is

> worthless and perhaps even harmful, government researchers say.

>

> The study looked at arthroscopic knee surgery for osteoarthritis,

the

> painful, steadily worsening, wear

> and tear on joints that affects 12 percent of senior citizens. The

> operation is done to clear out debris or

> repair damaged cartilage.

>

> In a type of study only rarely conducted, some patients got a real

knee

> operation, while others

> underwent sham surgery.

>

> At every point over the next two years, those who had the fake

surgery

> could climb stairs and walk

> slightly faster on average than those who had gotten real

operations.

>

> In arthroscopic surgery, a flexible viewing tube called an

arthroscope

> lets the surgeon see inside a joint.

> Only tiny incisions are needed, and patients heal quickly.

>

> Arthroscopic knee surgery for osteoarthritis costs roughly $5,000,

or a

> total of $1.5 billion a year in

> the United States, said Dr. Nelda Wray, a researcher at the Houston

VA

> Medical Center who led the

> study.

>

> " We think that money could be better spent, " she said.

>

> The findings could prompt insurance companies to refuse to pay for

the

> procedure. Other treatments

> for arthritic knees include pain relievers, cortisone shots, hot

packs,

> exercise and, as a last resort,

> knee-replacement surgery.

>

> Dr. W. Tipton Jr., executive vice president of the American

> Academy of Orthopedic

> Surgeons, said other researchers should duplicate the results before

> doctors, patients and insurance

> companies react. But he said the study confirms some doctors'

growing

> suspicions.

>

> He said many orthopedic surgeons already feel that arthroscopic

surgery

> should not be used except in

> certain circumstances, such as acute sports injuries to ligaments.

Tipton

> added that he has arthritis but

> is opting for knee replacement surgery.

>

> The study was published in Thursday's New England Journal of

Medicine (

> news - web sites).

>

> Surgical procedures are often not subjected to the kind of rigorous

> testing done on medications. Some

> critics consider sham surgery unethical because of the risk of harm

to

> study volunteers.

>

> But Sam Horng and lin G. of the National Institutes of

Health

> ( news - web sites) said in

> an accompanying editorial that the VA study " exemplifies the

ethically

> justified use of placebo surgery. "

>

> In the study, 180 veterans 75 or younger were divided into three

groups

> for arthroscopic surgery at the

> medical center, all done by the same expert surgeon between 1995 and

1998.

>

> One-third had arthroscopic debridement, in which debris and rough

and torn

> pieces of cartilage are

> removed or sanded down. Another third had arthroscopic lavage, in

which

> debris and calcium

> phosphate crystals are flushed out. The remaining third likewise

were

> anesthetized and had three

> incisions made in the knee, but the surgeon only manipulated the

knee as

> if working on it.

>

> No one knew which procedure they had for two years, during which

they

> received regular evaluations.

>

> During that period, all three groups said they had slightly less

pain and

> better knee movement, with the

> sham-surgery group often reporting the best results. That apparently

> reflects the well-known " placebo

> effect, " in which patients feel better simply because they believe

they

> have been treated.

>

> However, tests in which the patients were timed as they walked and

climbed

> up and down stairs found

> that patients in the two treatment groups were slower than they were

> before surgery.

>

> For much of the study, patients in the sham-surgery group were

faster than

> they were before the

> operation. By the end of the two years, though, they were about the

same

> as they were before the

> sham surgery, because their knees continued to deteriorate.

>

> Dr. Todd P. Stitik, associate professor of rehabilitation at

University of

> Medicine and Dentistry of New

> Jersey in Newark, said patients he has sent for arthroscopic surgery

were

> not helped much.

>

> " I don't think this is now necessarily a reasonable option, " he

said.

>

> He said his patients have benefited more from a relatively new

treatment -

> injections of a synthetic

> version of fluid inside the knee that acts as a