How effective is arthroscopic surgery for the knee?
Arthroscopy – one of the most common surgical options for arthritic knees. A procedure that most patients with knee pain have been offered at some point in their process.
What is an arthroscopy?
This is a “keyhole” surgery procedure where an arthroscope camera is inserted through a small incision in the knee, allowing the surgeon to view the inside of the knee.
The surgeon can then use other micro instruments inserted through additional small holes to remove small areas of tissue.
What does it do?
That, ladies and gentlemen, is the million dollar question. What does it do?
According to recent studies, not an awful lot.
This study divided patients into 3 groups:
- Incision with lavage (washing out the joint with a saline solution to get rid of any loose irritants) and debridement (removing small amounts of tissue within the joint)
- Incision with lavage only
- Incision only (placebo – sham surgery)
And guess what they found? All THREE groups improved exactly the same amount.
That’s right, whether the patients had a complete arthroscopy, just a “rinse” or nothing at all they all improved the same amount.
A procedure with exactly the same success rate as placebo. In my opinion that doesn’t seem like an effective solution.
Why is it still an option?
Because patients want to do something.
When treating arthritis and knee pain the 2 most common routes are surgery or pain relief medicine. Neither of which are actually terribly effective (see the recent changes regarding paracetamol – exercise is better!) unless you qualify for a full or partial knee replacement.
But how frustrating is it to be told that there is “nothing that can be done” or that you have to “wait until it is bad enough for a knee replacement”???
So this is something to do. It might make you feel better, it might not, but at least the doctor did something.
So what do I do?
- As the recent study suggests you can take a bit more exercise.
- People find Omega 3’s and Glucosamine with chondroitin can be helpful (again the studies are mixed).
- Get your knee straight!
- For my patients the best route forward is MRT combined with a full gait analysis so that we prevent you walking the problem back in. This has a 90% success rate here in my clinic (quite a bit higher than an arthroscopy!).