from Bloomberg

By Nicole Ostrow

Sept. 10 (Bloomberg) — As many as 300,000 knee surgeries performed in the U.S. each year to alleviate arthritis pain may be unnecessary because the procedure doesn’t work for the condition, according to researchers.

A study by Canadian doctors found that patients who had arthroscopic knee operations and took medications and physical therapy had no more improvement in pain or function after two years than those getting just drugs and therapy. The study is published in tomorrow’s New England Journal of Medicine.

The findings support a 2002 study by doctors at the Veterans Affairs Medical Center in Houston that met with criticism after concluding knee surgery for arthritis patients offered no benefit over medical therapy. The latest research may change the practice of many orthopedic surgeons, said Brian Feagan, professor of medicine from the University of Western Ontario in Canada and the study’s lead author.

“A lot of orthopedic surgeons were questioning whether the procedure should be abandoned after the” 2002 study, said Feagan, in a Sept. 9 telephone. “Now I think the penny is going to drop here. There are other ways to treat osteoarthritis of the knees.”

Arthroscopy is one of the most common orthopedic operations, and is performed most often on the knee and shoulder. The surgeon makes an incision, inserts a small instrument with a lens to see under the knee cap and makes repairs.

About 985,000 arthroscopic knee surgeries were performed in the U.S. in 2006, the latest year for which data is available, up from 657,000 in 1996, according to the National Survey of Ambulatory Surgery conducted by the National Center for Health Statistics. Feagan estimates 20 to 30 percent of the procedures performed each year are on arthritic knees.

Avoid Surgery

Some surgeons were critical of the 2002 study because it included mostly men who were generally sicker than the population overall, said Feagan. Now with two studies showing parallel findings, physicians should avoid knee operations to treat patients with arthritis, he said.

For mild-to-moderate knee pain, patients can use medicines such as Johnson & Johnson’s Tylenol or ibuprofen or try cortisone injections and a knee brace. Physical therapy is also effective. For those with severe pain, total joint replacement is an option, Feagan said.

The 172-patient study excluded those with arthritis who had large cartilage tears in the knee. Doctors say these patients may still benefit from the surgery.

Not For Arthritis

“If someone has arthritis and they don’t have another problem in their knee that’s causing them pain, then arthroscopy is not going to be more effective then just standard non- operative treatment,” said Robert Marx, an orthopedic surgeon at the Hospital for Special Surgery in New York and author of an editorial in the journal, in a Sept. 9 telephone interview. “What they also need to understand is that arthroscopy does have great value for people with arthritis but not to treat arthritis, just to treat other problems.”

About 21 million adults in the U.S. have arthritis, according to the Centers for Disease Control and Prevention in Atlanta.

A second study released by the New England Journal of Medicine found that one-third of older people had a tear in the cartilage, or meniscal ligaments, in the knee even when they didn’t have any pain or stiffness. These tears often accompany arthritis of the knees.

Meniscal damage in the right knee is common in middle aged and elderly people in the U.S. and increases as people age, according to the study.

While doctors frequently use magnetic resonance imaging, or MRI, to diagnose damage to the cartilage, a lack of data on the prevalence of the condition has made it difficult to differentiate between pain caused by a tear and pain caused by another problem, such as arthritis, researchers said.

To contact the reporter on this story: Nicole Ostrow in New York at nostrow1@bloomberg.net.

Last Updated: September 10, 2008 17:00 EDT

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