Arthroscopic surgery is a common treatment for moderate to severe knee arthritis. Through scopes inserted through small incisions the knee is irrigated and irregularities in the cartilage are shaved off.
In fact, no study has ever demonstrated that this surgery is effective for arthritis. Even worse, in a study in 2002 that randomized patients with knee arthritis to either arthroscopic surgery or sham surgery (in which skin incisions are made but nothing is done to the joint), the surgery group did no better than the sham surgery group.
Nevertheless, old habits die hard, especially when the habit is a very lucrative but ineffective procedure.
This week a study in the New England Journal of Medicine helped solidify the negative scientific data for arthroscopy for knee arthritis. In the study patients with moderate to severe knee arthritis were assigned to two groups. One group received arthroscopic knee surgery, physical therapy and medications. The second group received only physical therapy and medications. There was no difference in symptom scores between the two groups during the following 24 months.
Experts are now asking orthopedists to stop offering this procedure for arthritis patients. Of course, many ethical doctors won’t do ineffective procedures, but others will simply shoot the messenger and criticize minor flaws in this study. As long as some insurance companies pay the bill, some doctors will continue to offer it.
In a free society we can’t get rid of a bad product by shaming the providers. We do it by educating the customers.
New York Times article: A Study Revives a Debate on Arthritis Knee Surgery
New England Journal of Medicine study: A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee