Arthroscopic Knee Surgery, Worthless?

[tsearcher]

In an article published in the July 11, 2002 issue of the NEJM it was shown that "a "placebo" surgery, or a surgical procedure that simulated the effects of arthroscopic surgery, were just as likely to report pain relief as those patients that underwent the real surgery."

Here are some links discussing the issue:

http://www.baylorhealth.edu/proceedi..._1_jackson.htm
http://www.thefinalsprint.com/2006/11/ar...sually-useless/
http://www.usmedicine.com/article.cf...amp;issueID=41

This study was widely reported at the time. And as far as I can tell no one has been able to refute the findings. Additionally, I can't find any more follow up to this. The whole thing is unsettling to me.

It appears that a lot doctors are willing to recommend and perform surgeries that really have no benefit. It's not too surprising since this surgery is relatively simple with small risk. And the doctor will be get a nice pay check without much work. But what does surprise me, is that the insurers are willing to cover a useless surgery.

The numbers are a little misleading but I've seen that this operation is performed roughtly 650,000 times a year in the U.S. at a cost of roughly $5000 per operation. That's a lot of money. Why does this continue?

[Matt R.]

Just to be clear, based on the first link they are talking about arthroscopic surgery specifically for the treatment of osteoarthritis. Is this correct?

The reason I say this is because arthroscopic surgery, in general, is a very useful surgical technique. I had my ACL repaired arthroscopically, and it is much less invasive than other methods. Are the numbers you quoted for treatment of osteoarthritis, or for arthroscopic procedures in general?

[tsearcher]

[ QUOTE ]
Just to be clear, based on the first link they are talking about arthroscopic surgery specifically for the treatment of osteoarthritis. Is this correct?

The reason I say this is because arthroscopic surgery, in general, is a very useful surgical technique. I had my ACL repaired arthroscopically, and it is much less invasive than other methods. Are the numbers you quoted for treatment of osteoarthritis, or for arthroscopic procedures in general?

[/ QUOTE ]

I believe you are correct. I was too general in my post. I am talking specifically for surgery performed to relieve pain, not to correct a defect.

I got those numbers from a half assed search and probably do include all surgeries not just to relieve pain.

[bkholdem]

I had this surgery after tearning my miniscus (sp?) and am pretty glad I did. I can't imagine getting the same results by someone sprinkling pixie dust over my knee and chanting.

[vhawk01]

[ QUOTE ]
[ QUOTE ]
Just to be clear, based on the first link they are talking about arthroscopic surgery specifically for the treatment of osteoarthritis. Is this correct?

The reason I say this is because arthroscopic surgery, in general, is a very useful surgical technique. I had my ACL repaired arthroscopically, and it is much less invasive than other methods. Are the numbers you quoted for treatment of osteoarthritis, or for arthroscopic procedures in general?

[/ QUOTE ]

I believe you are correct. I was too general in my post. I am talking specifically for surgery performed to relieve pain, not to correct a defect.

I got those numbers from a half assed search and probably do include all surgeries not just to relieve pain.

[/ QUOTE ]

Lecturer at my school spent a good half-hour talking about this study last year, including what the implications are and what it demonstrates about surgery in particular and medicine in general. He made the point that we are only recently starting to move towards an evidence-based model, and surgery lags way behind. I thought this was shocking...what ELSE would you use, rather than evidence-based?

Anyhow, I don't think that many surgeons still perform scopes for osteoarthritis.

[vhawk01]

[ QUOTE ]
I had this surgery after tearning my miniscus (sp?) and am pretty glad I did. I can't imagine getting the same results by someone sprinkling pixie dust over my knee and chanting.

[/ QUOTE ]

Yeah, its not for that. Basically, someone comes in with chronic knee pain, generally an older person, and imaging shows no problems. So, they scope it, 'clean it out,' and the patient reports less pain. No real medical reason to think it does anything, but it seemed to work. So they tested it, they made a cut on someones knee but didn't do anything. Just bandaged it back up. Patients reported their knee felt a lot better.

These types of findings aren't rare AT ALL, especially when it comes to pain management.

[tsearcher]

[ QUOTE ]

Yeah, its not for that. Basically, someone comes in with chronic knee pain, generally an older person, and imaging shows no problems. So, they scope it, 'clean it out,' and the patient reports less pain.


[/ QUOTE ]

I was under the impression that it is generally younger patients that receive this procedure. It is meant as short term pain relief, until the patient is old enough to have a knee replacement.