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Need for arthritis surgery challenged

Two studies call into question whether many people with arthritis are needlessly undergoing one of the most common operations in America: arthroscopic knee surgery.

One study finds surgery is no better than medication and physical therapy for relieving the pain and stiffness of moderate or severe arthritis. The other reveals that tears in knee cartilage – which often prompt the surgeries – are common without causing symptoms.

Experts said the new studies and other evidence show that arthroscopic knee surgery still has a place, such as after an injury, but shouldn't be done routinely for osteoarthritis.

“A lot of people would prefer physical therapy, and their doctors would, as well,” said Dr. Anthony Rankin, spokesman for the American Academy of Orthopedic Surgeons.

The studies are in today's New England Journal of Medicine.

Nearly 27 million Americans have osteoarthritis, a top cause of disability. Symptoms usually begin after age 40 and progress as a breakdown of cartilage causes the ends of bones to rub together at joints, leading to stiffness and pain, and limiting movement.

One answer is arthroscopic surgery, in which a scope with a mini camera is inserted through a tiny incision, and surgeons operate through other tiny cuts. Surgeons typically smooth damaged cartilage and flush out bone chips. This allows faster healing than traditional surgery, but can still trigger blood clots, infection, and nerve or blood-vessel damage.

About 1 million such surgeries occur in the U.S. yearly, each costing about $7,000 as an outpatient procedure.

A large study in 2002 found the operation no better than surgery in which incisions are made but no instruments enter the joint, but the procedure remains popular.

The new study, at the University of Western Ontario in Canada, included nearly 200 patients with moderate to severe osteoarthritis. Half got medication, physical therapy and instruction on exercises to do at home. The other half got those treatments plus arthroscopic surgery.

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