Popular knee operation no better than fake surgery for many, study finds
Thousands have undergoneunnecessary torn cartilage operations, the most common orthopaedic procedure in the US, says study
A popular surgical procedure worked no better than fake operations in helping people with one common knee problem, suggesting that thousands of people may be undergoing unnecessary surgery, a new study found.
The unusual study involved people with a torn meniscus, crescent-shaped cartilage that helps cushion and stabilise knees. Arthroscopic surgery on the meniscus is the most common orthopaedic procedure in the United States, performed, the study said, about 700,000 times a year at a cost of US$4 billion.
The study, conducted in Finland and published in The New England Journal of Medicine, involved a small subset of meniscal tears. But experts, including some orthopaedic surgeons, said the study added to other recent research suggesting that meniscal surgery should be aimed at a narrower group of patients and that, for many, options like physical therapy may be as good.
The surgery, arthroscopic partial meniscectomy, involves small incisions. They are to accommodate the arthroscope, which allows doctors to see inside, and the tools used to trim torn meniscus and to smooth ragged edges of what remains.
The Finnish study does not indicate that surgery never helps; there is consensus that it should be performed in some circumstances, especially for younger patients and for tears from acute sporting injuries. But about 80 per cent of tears develop from ageing, and some researchers believe surgery in those cases should be limited.
"Those who do research have been gradually showing that this popular operation is not of very much value," said Dr David Felson, a professor of medicine and epidemiology at Boston University. This study "provides information beautifully about whether the surgery that the orthopaedist thinks he or she is doing is accomplishing anything. I think often the answer is no."
Volunteer patients in the study received anaesthesia and incisions. But some had actual surgery, others simulated procedures. They did not know which.
A year later, most patients in both groups said their knees felt better, and the vast majority said they would choose the same method again, even if it was fake.
"It's a well-done study," said Dr David Jevsevar, a surgeon in Utah who chairs the committee on evidence-based quality and value of the American Academy of Orthopaedic Surgeons. "It gives further credence … to studies that have shown that arthroscopy is not always going to make a difference."
Jevsevar said he hoped the study would spur research to better identify patients who should have surgery. The new research builds on a 2002 study, showing that patients receiving arthroscopy for knee osteoarthritis fared no better than those given sham surgery. A 2008 study found that patients undergoing surgery for knee arthritis did no better than those taking physical therapy and medication. Many surgeons no longer operate on patients with only knee arthritis.