Should you have surgery for arthritis in your knees?

Posted on August 22, 2011

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I was recently being diagnosed with a torn meniscus from playing football. Thus, I’ve been looking up a lot of research on various knee surgeries lately.

I have a good base of knowledge but I find I tend to go through phases where a specific condition or joint tends to predominate in my life or in my clients. That leads me to see what new things I can learn related to that condition or joint.

While researching different forms of knee surgery I came across this AWESOME paper on arthroscopic surgery on the knee for people with osteoarthritis.

Without going into too much detail in this post, I’ve always been (very) skeptical of the majority of knee surgeries done on people. Specifically arthroscopic surgery for “cleaning” out the knee. This would consist of cleaning up the meniscus, bone spurs, etc. This is a big part of what’s done in knee surgery for arthritis.

The first reason for this is there are a lot of people walking around with a beat-up meniscus who aren’t in any pain. This review paper cites a study showing that 59% of basketball players and endurance runners (people who beat the hell out of their knees) have a full thickness chondral defect in at least one of their knees, yet they aren’t in any pain! (Shout-out to Eric Cressey for posting that research.)

In simpler terms: there are studies showing the majority of certain athletes aren’t in pain yet still have a full tear of their cartilage.

Furthermore, there are plenty of people who are in constant knee pain yet will have no abnormal findings, such as a meniscal tear, show up on a MRI.

Ironically, in my own experience, from the time I was 17 til I was about 19, I was in near constant knee pain. It was never excruciating but it was there. During that time period I had a MRI done which came back flawless. Fast-forward to now and I have a torn meniscus (verified by MRI) and barely have any knee pain.

The second reason I’m not a big fan is based on the amount of people I have talked to and seen post-surgery: it seems to almost be a toss-up as to whether or not the surgery gives them any pain relief.

One thing I have seen a few times is those who are religious about their post-op rehabilitation report better results than those who are not. Again, this is simply anecdotal and I don’t have data to back this up. Just what I’ve noticed.

Going along with the above though, perhaps it’s not the surgery that gives the person relief but it’s the strict adherence to their physical therapy that does. Again, so many have surgery and feel the same afterwards it’s hard to say the surgery did anything positive for them.

At the same time, there are a lot of people who get no relief from physical therapy either. Maybe the people post-surgery are much more adherent to their therapy than before the surgery though, and that’s why they’re now getting relief? Maybe it was just a poor physical therapy program to begin with? Hard to say.

And that brings us to this ridiculously awesome paper I found:

A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee

Here’s a quick rundown of this study: They took two groups of people. One group would have surgery designed to clean up the knee with arthroscopic surgery. The other would have placebo surgery.

You know how drug studies give one group the actual drug and another group a sugar pill, yet the group who took the sugar pill will report effects similar to the drug group? These researchers wanted to see if the same thing would happen, but with surgery.

So both groups knew they were going to have surgery, but one group went through all the actual prep and action of surgery without anything specifically done to help the knee.

Yet this group, who was checked on intermittently for TWO YEARS, reported the same results as the group who actually had surgery!

 

Click to make the images bigger:

arthroscopic knee surgery

The lavage and debridement group are similar for the purpose of this post i.e. they both had actual knee surgery designed to clean up the knee and alleviate arthritis. Minimal improvements in the amount of pain post-surgery are seen here

 

arthroscopic knee surgery

Improvement in the function of the knee in ALL groups can be seen here

For anyone who is considering, or might ever have to consider having surgery to help alleviate pain associated with arthritis of their knee(s), this study should really make you stop and think. Based on this paper, and my own experience as well, chances are you’re going to have minimal, if any improvement in your pain. Yet you’ll still have to deal with all the issues that come along with having to go through surgery.

From the paper:

If the efficacy of arthroscopic lavage or débridement in patients with osteoarthritis of the knee is no greater than that of placebo surgery, the billions of dollars spent on such procedures annually might be put to better use.”

Unfortunately, this doesn’t seem to have remotely happened. If anything, we are even more prone to cutting people open despite the lack of evidence for doing so.

One negative about this paper is the fact the sampling for the study was done about 15 years ago. The advances in technology and surgical techniques could possibly change the results of this study if it were done now. Based on the experiences I’ve had with people who’ve recently had surgery akin to the surgeries done in this paper, I highly doubt it.

So it would appear that “fixing” or “cleaning” out the knee doesn’t do much for pain relief or the function of an arthritic knee. The issue here is not that when looking at a MRI the inside of the knee looks all chewed up. The issue is figuring out what caused the knee to become all chewed up to begin with. And no, “age” does not qualify as a sole cause.

Other charts from the paper illustrating the results:

Should I have arthroscopic knee surgery

Pain after knee surgery

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