The world’s most common orthopedic procedure — knee arthroscopy — is frequently a waste of time and money and should almost never be performed on patients with degenerative knee disease.
That’s the conclusion of an international panel that strongly recommends against arthroscopic surgery in a new guideline published by the BMJ. The panel found that, while performed 2 million times per year worldwide, knee arthroscopy offers minimal benefits to patients with degenerative knee disease, which affects about 25 percent of people older than 50.
The surgery’s persistence may have to do with a combination of financial incentives, patient frustration at more conservative approaches, and delays in incorporating new evidence into current practice, the panel said.
The guideline does not just apply to those with arthritis, a finding that has already been described, but a much broader set of patients who have meniscus tears, sudden onset of pain, and mechanical symptoms, such as clicking or catching of the knee. The panel, which examined studies involving more than 1.8 million patients, found that people who receive surgery do not see meaningful improvements in “long term pain or function” compared to those who rely on exercise, weight loss, medications, and other less invasive approaches.
The panel also concluded that additional research is unlikely to alter its advice. “You could do another trial, but it’s almost certain to show the same thing,” said Dr. Reed Siemieniuk, chair of the panel and a physician at McMaster University in Hamilton, Ontario, Canada.
So case closed? No more surgery for patients with degenerative knee disease?
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