A common form of knee surgery – carried out on 150,000 people in the UK each year – has only “inconsequential”, short-term benefits over exercise or a placebo treatment for middle aged and older patients, experts have said.
The findings, combined with evidence of rare but serious side effects, “do not support” using arthroscopic knee surgery to treat pain in this age group, the researchers from hospitals in Demark and Sweden concluded.
Responding to the study, one leading UK orthopaedic surgeon said that mounting evidence against the procedure could soon lead to a “swift reversal of established practice”.
Despite being common practice, arthroscopic knee surgery reduced pain only slightly more than exercise or placebo treatments up to six months after the operation, the researchers found.
Beyond six months, there was no evidence of benefit in either pain reduction or physical functioning, according to the review of nine previous trials.
Average of patients in the studies ranged from 48 to 63-years-old.
The study, published in the BMJ, as part of the journal’s Too Much Medicine campaign, which aims to reduce the costs and harms of unnecessary treatments, also looked at nine previous studies on the side effects of knee surgery.
Deep vein thrombosis (DVT) was the most frequent, occurring four times for every 1,000 operations. One patient for every 1,000 operations died, according to the study. Although rare, the sheer number of operations taking place meant that changing practice could save “a substantial number of lives”, said Professor Andy Carr, of Oxford University’s Institute of Musculoskeletal Sciences.
“Supporting or justifying a procedure with the potential for serious harm, even if this is rare, is difficult when that procedure offers patients no more benefit than a placebo,” he wrote in the BMJ, in response to the new study.
“We may be close to a tipping point where the weight of evidence against arthroscopic knee surgery for pain is enough to overcome concerns about the quality of the studies, confirmation bias and vested interests. When that point is reached, we should anticipate a swift reversal of established practice.”Reuse content