Does Waiting Out Knee Pain Work?
Studies Suggest Arthroscopic Knee Surgery Doesn't Offer Healing Advantage
In the first of these trials -- from Texas in 2002 -- patients who had knee pain attributed to cartilage damaged by osteoarthritis received either an arthroscopic repair or a sham procedure, in which incisions were made but no surgery was actually performed. The patients, who were made aware of the possibility that some participants might get a sham procedure, did not know whether they got the real thing. In the end, there was no significant difference in the patients' outcomes when comparing the two groups.
In a second trial performed in Canada, patients received either the arthroscopic repair or "conservative" care, including physical therapy. In the course of two years, the surgery did not offer any advantage over the less invasive approach, the study's authors reported last month.
A Canadian-style trial would not come up with the same result in the United States. Most patients in the United States have the preconception that the surgery must be better because the knee feels better after surgery. Now we know such surgery offers the patient's knee no specific advantage.
The American orthopedic community is quick to explain that it reserves its arthroscopic surgery for patients with different causes of knee pain, such as meniscal or ACL tears, and that it is particularly adept at choosing the patients with osteoarthritis likely to be helped. My response is, "SHOW ME" with randomized, well-executed, sham-controlled trials.
Until the community does, I will advise my patients with regional knee pain to do the best they can, try an exercise bicycle or water aerobics and be patient. This too shall pass.
Dr. Nortin Hadler is professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and an attending rheumatologist at University of North Carolina Hospitals. He is the author of "Worried Sick: A Prescription for Health in an Overtreated America" and "The Last Well Person."
Do you have more information about this topic? If so, please click here to contact the editors of ABC News.
