Common Knee Surgery To Treat Arthritis No More Effective Than Prescription Drugs, Physical Therapy, According to Study

A common method of surgery for treating moderate to severe osteoarthritis of the knee is no more effective over two years than nonsurgical treatment using physical therapy and medications, according to a study published Thursday in the New England Journal of Medicine, USA Today reports (Brophy Marcus, USA Today, 9/11). Arthroscopic knee surgery is a method in which a surgeon inserts a tiny camera through an incision in a patient's knee and several small tools through another incision to clear out cartilage fragments, bone spurs and other debris. The procedure is thought to allow quicker healing (Johnson, AP/Philadelphia Inquirer, 9/11). According to lead researcher Brian Feagan of the University of Western Ontario, about 950,000 patients per year have arthroscopic knee surgery, which can cost about $5,000, and about one-third of those procedures are for patients with arthritis.

For the study, researchers examined 178 patients with an average age of 60. All patients received standard nonsurgical treatment, which included physical therapy; painkillers such as acetaminophen and ibuprofen; glucosamine supplements; and injections to lubricate the joint. Eighty-six of the patients also underwent arthroscopic surgery (Stein, Washington Post, 9/11). Patients were evaluated over two years using a scoring system that measured pain, stiffness and physical function. After three months, the surgery group initially showed more improvement, but two years after the procedure, there was no significant difference between the groups.

The results support the findings of a 2002 Department of Veterans Affairs study, the Wall Street Journal reports. Feagan said, "We now have two independent, well-controlled trials that demonstrate that the procedure is ineffective." He added, "I think that will change practice" (Tomsho, Wall Street Journal, 9/11). E. Anthony Rankin, president of the American Academy of Orthopaedic Surgeons, said, "As a tool for treating arthritis alone, it probably isn't a good tool" (Kolata, New York Times, 9/11).

In an accompanying editorial, Robert Marx, an orthopedic surgeon at Weill Cornell Medical College of Cornell University, wrote that the study provides "strong support" for the conclusion that "arthroscopic surgery is not effective therapy for advanced osteoarthritis of the knee." In an interview, Marx said that the procedure could offer benefits for patients experiencing additional knee problems (Wall Street Journal, 9/11). Feagan expressed concern that such an attitude could lead to continued overuse of the procedure. He said, "I am very disappointed by the editorial. I'm not sure who he is advocating we should treat" (Washington Post, 9/11).

The study is available online. The editorial also is available online.

Broadcast Coverage
NBC's "Nightly News" on Wednesday reported on the study. The segment includes comments from Robert Litchfield of the University of Western Ontario, patient Steve Studenny and Marx (Bazell, "Nightly News," NBC, 9/10).

NPR's "All Things Considered" on Wednesday also reported on the study. The segment includes comments from Steve Studenny, a 58-year-old man who underwent the surgery; Feagan; and Marx (Neighmond, "All Things Considered," NPR, 9/10).