The human knee may be the most complicated joint in the body. It supports the body’s weight while remaining flexible enough to facilitate walking, sittings, and kneeling. It is no wonder that the knee wears out quickly in comparison with other joints, and that approximately one quarter of all adults older than 50 experience pain from degenerative knee disease. Arthroscopic knee surgery has been used to relieve such pain, yet it may not be the most effective treatment method.
What Is Arthroscopic Knee Surgery?
A knee arthroscopy is a surgical procedure designed to minimize the disruptiveness of traditional knee surgery. Historically, knee surgery has required physicians to make a large incision into the knee to acquire basic diagnostic information. Arthroscopic knee surgery makes the process less invasive by utilizing small incisions and finer tools.
The physician makes an incision just large enough to insert an arthroscope, a small tube containing a system of lenses, a small video camera, and a light. The arthroscope allows surgeons to see the inside of the knee joint through images relayed onto a video monitor. In this way, more informed diagnoses can be made and knee surgery can be performed in finite detail without dramatically cutting open the knee.
Because the procedure is less invasive, with thin instrumentation and minimal cutting, the soreness of recovery is also usually reduced. Recipients of knee arthroscopies have shorter and less painful recovery times, getting back to restored and even activity more quickly.
Is Having a Knee Arthroscopy Worth It?
Especially at first glance, arthroscopic knee surgery seems like the best way to treat degenerative knee disease. The success rate is high—over 90%—and the treatment is commonly administered (amounting to over two million surgeries performed around the world each year).
Knee arthroscopies are not without their risks. Physicians assess each case before surgery, but not all problems can be foreseen. As is the case with every medical procedure, complications may arise. These may include infection, blood clotting, nerve damage, and other residual pain. Many consider the chance of restored knee function to be worth the risk, but the principal downside of arthroscopic knee surgery is that it is not as effective as we may think.
New Evidence on the Rise
In Arthroscopic Surgery for Degenerative Knee Arthritis and Meniscal Tears, a study published in the British Journal of Sports Medicine in March 2018, authors Siemieniuk, et al. illustrate that the high success rate of arthroscopic surgery may not be as informative as previously supposed. While the treatment provides initial relief from knee pain, it does not on average provide improvement in long term pain or functionality. Alternative treatment, such as exercise therapy, may be just as effective.
A Comprehensive Study
The goal of Siemieniuk, et al.’s study was to compile a systematic review on the net benefit of arthroscopic knee surgery, comparing data from 13 randomized trials in conjunction with 12 observational studies. The data of more than 1.8 million patients were considered by a panel of orthopedic surgeons, physiotherapists, methodologists, epidemiologists, a general practitioner, a rheumatologist, and those with lived experience of degenerative knee disease.
The authors reviewed the data to discover the role arthroscopic surgery plays in degenerative knee disease, assessing its value against non-operative care.
While most recipients of arthroscopic surgery reported minimized pain levels after the traditional recovery period, fewer than 15% of the study’s participants experienced any improvement in knee functionality and pain three months after the surgery took place. In none of the subgroups studied did any of the participants feel any improvement one year post-surgery.
Siemieniuk, et al. concluded that for patients with true locked knees, arthroscopic knee surgery was a lastingly effective treatment method. For cases of degenerative knee disease that did not inhibit full extension of the knee, the risks of harm outweighed the benefits of knee arthroscopy, which did not provide enduring benefits to any of the subgroups studied.
While acknowledging the rarity of adverse side effects to the surgery, the authors considered the risks in addition to the burden of undergoing surgery and recovery of higher value than any temporary benefits. They also proposed that “marked improvements after arthroscopy” may have been the results of degenerative knee disease’s natural fluctuating course, contributions of other therapies performed as part of the recovery process, or placebo effects.
Other Treatments for Knee Pain
The research of Siemieniuk, et al. suggested that exercise therapy prescribed during surgery recovery was as or more effective than the knee surgery itself. If you are looking for pain relief or renewed functionality in your knees, you may consider this non-invasive alternative to surgery. Consult with your doctor to discover what is best for you.
Leave a Reply