Don't Be So Fast to Knock Knee Surgery

When a recent study found that a popular knee operation was only as good as a placebo for arthritis, some sufferers misconstrued the results, assuming that no surgery would help them.

Doctors are now trying to reassure people this isn't the case.

The research, published two weeks ago in the New England Journal of Medicine, found that arthroscopic knee surgery, in which a surgeon inserts small instruments into the knee to explore the damage and make repairs, provided only mild relief at most for arthritis sufferers. Patients undergoing the surgery, the study said, had the same degree of pain relief as those who had a simulated procedure, in which tiny incisions were made and nothing more was done. Two years later, about 35% of study subjects thought they had improved; 65% either felt worse or stayed the same.

"Patients that have arthritis read this as saying any knee surgery for arthritis doesn't work," said Dr. Larry Dorr, director of the Arthritis Institute at Centinela Hospital in Los Angeles.

Arthroscopy remains a good operation for those who have suffered knee trauma and acute injury, such as an athlete with torn cartilage or a weekend athlete who tears a meniscus or ligament, he said.

For those with painful, stiff, arthritic knees who can't get relief any other way, there are procedures to help.

"Total knee replacement is a highly successful operation and it's shown to be one of the most effective treatments in terms of returning people to productivity." Although knee replacements are painful and rehabilitation can take up to a year, he said, "as with most things in life, God gives you something when he takes something away. They last better" than less invasive operations.

Many doctors began offering the simpler arthroscopy, Dorr said, because patients were reluctant to endure the pain, cost and prolonged recuperation of knee replacement. But, he said, "there was no one overlooking it and saying, 'This isn't working and we should stop.' "

With arthritis, the procedure typically involves debridement, the sanding down of rough or damaged cartilage lining the knee, and lavage, which flushes cartilage fragments from lubricating joint fluid.

Up until the recent study, there hadn't been scientific comparisons of arthritis patients who underwent the surgery with those who got a dummy procedure. Two years after the procedures, about 35% of all the subjects thought they had improved; 65% felt worse or stayed the same. However, the improvements were generally in perceived pain, not in any objective measure of whether they could function better, said Dr. Nelda P. Wray, the study's senior scientist.