Arthroscopic knee surgery for arthritis -- a procedure performed hundreds of thousands of times a year -- does not reduce joint pain or improve knee function, according to new research released Wednesday.
The study of 178 adults with moderate to severe arthritis found that the surgery, in which damaged bone and cartilage are removed through tiny incisions, had no benefits beyond nonsurgical treatments, such as physical therapy.
The report in the New England Journal of Medicine confirmed the results of a 2002 study that caused many orthopedic surgeons to discontinue the practice. Others continued to perform the surgeries, dismissing the earlier study because its subjects were predominantly men.
The latest report should put all doubt to rest, said Dr. Brian G. Feagan, a professor of medicine at the University of Western Ontario in Canada and a study author.
"We now have two data points saying the surgery is ineffective for arthritis," he said. "It should not be performed."
Arthroscopic knee surgery is a minimally invasive technique in which surgeons are guided by images transmitted from a tiny camera inserted into the joint. The method has a range of applications for which it is considered effective, such as repairing cartilage and ligament tears from sports injuries.
There were 985,000 arthroscopic knee surgeries in the United States in 2006, according to the most recent figures available from the national Centers for Disease Control and Prevention.
Feagan estimated that 200,000 to 300,000 of those surgeries were for arthritis. The surgery typically is performed as an outpatient procedure at a cost of about $7,000.
Arthritis, which usually begins after age 40, affects nearly 27 million Americans. In arthritis, the cartilage that protects bones at the joints breaks down, causing bones to rub together. Symptoms include pain and stiffness.
The study divided patients into two groups -- one receiving the surgery and the other serving as a control. People with large cartilage tears were excluded from the study.
All participants received one hour of physical therapy weekly for 12 weeks and were assigned to perform exercises twice daily at home. In addition, all patients used pain relievers as needed and were offered oral glucosamine and injections of hyaluronic acid, a knee lubricant. Patients were tracked for two years.
