People in their 50s and older often get arthroscopic surgery for knee pain, but a new review of studies suggests that it has serious risks and no lasting benefits.
Danish researchers reviewed nine randomized trials including 1,270 patients ages 50 to 62. The patients had pain ranging from 36 to 100 on a 100-point scale, and surgery was compared with control treatments like sham surgery, drug treatment and exercise programs.
The studies involved only surgery for pain caused by degenerative conditions like osteoarthritis, not surgery to repair traumatic injury to cartilage or ligaments.
Surgery provided slightly more pain relief than controls in the first six months — 2.4 points lower on the 100-point scale. But there was no difference in pain scores between surgery and controls beyond that period, and there was no difference between the groups at any time in self-reported physical function.
The review, in BMJ, found that deep vein thrombosis was the most common adverse side effect of surgery, with about four events per 1,000 procedures. Less common were infection, pulmonary embolism and death.
The lead author, Jonas Bloch Thorlund of the University of Southern Denmark, said that doctors should share this kind of information with patients. “If patients are to engage in shared decision making,” he said, “they need this kind of information. There is very little to gain in this surgery, and there are harms.”
Source The New York Times
Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms, J B Thorlund, C B Juhl, E M Roos, L S Lohmander, BMJ 2015;350:h2747 doi: 10.1136/bmj.h2747