Knee Surgery: Not Always Worth It

Arthroscopic surgery to treat knee pain may provide little benefit and sometimes cause harm

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Older people with painful arthritic knees or torn cartilage often turn to surgery to fix the problem. Such operations, however, may have short-lived benefits and do more harm than good in some cases.

A new study has found that the advantages of some knee surgeries may be relatively small and disappear within one to two years. In some cases, the procedures may lead to further physical problems.

As many as 700,000 middle-aged and older patients in the US undergo arthroscopic surgery each year to treat degenerative joint disease, according to the National Center for Health Statistics. Specialists often recommend this type of procedure for persistent knee pain. It is performed with a scope that is inserted into the joint through a small incision.

J.B. Thorlund, PhD, associate professor with the Department of Sports Science and Clinical Biomechanics at the University of Southern Denmark in Odense, and colleagues conducted this research.

"Interventions that include arthroscopy are associated with a small benefit and with harms; the small benefit is inconsequential and of short duration," Dr. Thorlund and colleagues wrote. "The benefit is markedly smaller than that seen from exercise therapy. These findings do not support the practice of arthroscopic surgery as treatment for middle aged or older patients with knee pain with or without signs of osteoarthritis."

These researchers reviewed nine past studies representing 1,270 patients who reported on their benefits from knee surgery. On average, patients ranged in age from 48 to 63 years old. Follow-up periods were between three months and two years.

Surgery appeared to provide small but significant relief from pain at three months and six months but no longer than that compared with those who received other treatments. These other treatments included exercise and placebo surgery. In placebo surgery, patients believe they are getting surgery but no actual operation is performed.

Within one to two years, any benefit from surgery disappeared. The surgery did not appear to offer significant improvement in physical function.

Another nine studies considered the harms of knee surgery. Incidents were rare, but researchers noted cases of deep vein thrombosis (DVT), when a blood clot forms in a leg vein. A few leg surgeries also resulted in infection, pulmonary embolism (blockage of the main artery in the lung) or death.

“Supporting or justifying a procedure with the potential for serious harm, even if this is rare, is difficult when that procedure offers patients no more benefit than a placebo,” wrote Andy Carr, ChM, professor of orthopedic surgery with the Oxford University Institute of Musculoskeletal Sciences in the UK, in an editorial about this study.

Dr. Thorlund and team concluded that middle-aged patients with knee pain and tears in the meniscus (knee cartilage) should be considered as having early-stage osteoarthritis. Osteoarthritis is also called degenerative joint disease, or “wear and tear” arthritis. It is a chronic condition of the joints.

“It should be treated according to clinical guidelines for knee osteoarthritis, starting with information, exercise and often weight loss,” Dr. Thorlund and team wrote.

The study and editorial were published June 16 in The BMJ.

The study was part of The BMJ's “Too Much Medicine” campaign, which examines the threat to human health and the waste of resources caused by unnecessary care.

Dr. Thorlund and team disclosed no direct funding sources. One study author received support from Össur, Flexion Therapeutics, Medivir, Teijin, MerckSerono, Allergan and Galapagos.

Dr. Carr was funded by the NIHR Oxford Biomedical Research Unit and received research grants from NIHR and Arthritis Research UK.

Review Date: 
June 16, 2015
Last Updated:
June 18, 2015