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Health See other Health Articles Title: Arthroscopic Knee Surgery Shows No Long-term Benefit Medscape...The potential harms of arthroscopy to treat pain and poor functioning of a degenerative knee may outweigh the procedure's small pain relief benefits, which last less than 1 to 2 years after surgery, according to a systematic review and meta-analysis published online June 16 in the BMJ. "Arthroscopic surgery in the middle aged and older population with knee pain represents most arthroscopies and is routinely performed on the basis of a suspected meniscal tear by clinical examination or as diagnosed by magnetic resonance imaging, the reasoning being that the pain is associated with the meniscal tear," write Jonas Bloch Thorlund, PhD, from the Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, and associates. The available evidence, however, supports reversing this common medical practice, they add, while acknowledging the challenges of doing so, including surgeon confirmation bias, financial aspects, and administrative policies. "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," writes Andy Carr, ChM, DSc, FRCS, FMedSci, from the Botnar Research Centre, Oxford University Institute of Musculoskeletal Sciences, National Institute for Health Research Oxford Musculoskeletal Biomedical Research Unit, United Kingdom, in an accompanying editorial. Surgeons perform more than 700,000 knee arthroscopies in the United States, and more than 150,000 in the United Kingdom, he notes. Yet the imaging abnormalities often used to justify these procedures are common in the general population, and the findings of this meta-analysis suggest that "a substantial number of lives could be saved and deep venous thromboses prevented each year if this treatment were to be discontinued or diminished." The researchers identified all randomized controlled trials that appeared in five databases through August 2014 and assessed the benefits of arthroscopic surgery for patients, regardless of whether they had X-ray evidence of osteoarthritis. The studies had to include surgery with partial meniscectomy, debridement, or both, and the researchers included additional cohort studies, register-based studies, and case series studies from 2000 onward to determine harms. The nine trials they found included 1270 patients, with mean ages from 49.7 to 62.8 years, and follow-ups ranging from 3 to 24 months. The studies compared arthroscopy with control treatments such as exercise and sham surgery for patients whose mean baseline pain ranged from 36 to 63 mm on a 0- to 100-mm visual analogue scale. All participants in two trials, none in two others, and some in the remaining five had osteoarthritis determined by radiography. Using each study's end point, the analysis revealed a combined 2.4-mm (95% confidence interval [CI], 0.4 - 4.3 mm) improvement in pain compared with control treatments. The effect size for pain relief (0.14; 95% CI, 0.03 - 0.26) was similar to that for acetaminophen (0.14) and less than that seen from nonsteroidal anti-inflammatory drugs (0.29) and exercise therapy (0.50 regardless of dose or 0.68 for three times weekly). The pain relief seen at 3 and 6 months, ranging from 3 to 5 mm, also did not last to 24 months, and the analysis revealed no improved physical functioning (effect size, 0.09; 95% CI, −0.05 to 0.24). The most common harm identified from two randomized controlled trials and seven observational studies was deep vein thrombosis, occurring at a rate of 4.13 per 1000 arthroscopic meniscectomy procedures (95% CI, 1.78 - 9.60). Other harms included pulmonary embolism (1.45 per 1000 procedures; 95% CI, 0.59 - 3.54), infection (2.11 per 1000 procedures; 95% CI, 0.80 - 5.56), and death (0.96 per 1000 procedures; 95% CI, 0.04 - 23.9). Because some previous research has found surgeries to provide no greater benefit than placebo surgeries, "[t]he treatment effect associated with arthroscopic surgery of the knee may well have a placebo component," Dr Carr writes. Similar to the authors, he suggests that confirmation bias may be among the factors contributing to the continued use of arthroscopic surgery, despite the weak evidence base. "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," he writes. "When that point is reached, we should anticipate a swift reversal of established practice." One coauthor reported receiving funding from the Swedish Research Council funded and personal fees from Össur, Flexion Therapeutics, Medivir, Teijin, Merck Serono, Allergan, and Galapagos, as well as being the editor-in-chief of Osteoarthritis and Cartilage. Another coauthor reported receiving fees for lectures and royalties for books from Össur, the Finnish Orthopedic Society, Studentlitteratur, and Munksgaard, and being an associate editor of Osteoarthritis and Cartilage. Dr Carr reported receiving funding from the National Institute for Health Research Oxford Biomedical Research Unit and research grants from the National Institute for Health Research and Arthritis Research UK. BMJ. 2015;350:h2747, h2983. Article full text, Edtiorial full text http://www.medscape.com/viewarticle/846666 Editors' Recommendations Acetaminophen Ineffective for Back Pain, Knee/Hip OA Knee OA: Corticosteroid Shot Does Not Boost Exercise Benefit Stem Cells Safe, Reduce Arthritis Pain After Knee Surgery Topic Alert Related Drugs & Diseases Surgical Treatment of Medial Compartment Arthritis Ankle Arthroscopy Wrist Arthritis Poster Comment: Arthroscopic Surgery Definition Arthroscopic surgery is a procedure to visualize, diagnose, and treat joint problems. The name is derived from the Greek words arthron, which means joint, and skopein, which means to look at. Purpose Arthroscopic surgery is used to identify, monitor, and diagnose joint injuries and disease; or to remove bone or cartilage or repair tendons or ligaments. Diagnostic arthroscopic surgery is performed when medical history, physical exam, x rays, and other tests such as MRIs or CTs don't provide a definitive diagnosis. An arthroscope uses optical fibers to form an image of the damged cartilage, which it sends to a television monitor that helps the surgeon perform surgery. An arthroscope uses optical fibers to form an image of the damged cartilage, which it sends to a television monitor that helps the surgeon perform surgery. (Illustration by Argosy Inc.) Precautions Diagnostic arthroscopic surgery should not be performed unless conservative treatment does not fix the problem. Description In arthroscopic surgery, an orthopedic surgeon uses an arthroscope, a fiber-optic instrument, to see the inside of a joint. After making an incision about the size of a buttonhole in the patient's skin, a sterile sodium chloride solution is injected to distend the joint. The arthroscope, an instrument the size of a pencil, is then inserted into the joint. The arthroscope has a lens and a lighting system through which the structures inside the joint are transmitted to a miniature television camera attached to the end of the arthroscope. The surgeon uses irrigation and suction to remove blood and debris from the joint before examining it. Other incisions may be made in order to see other parts of the joint or to insert additional instruments. Looking at the interior of the joint on the television screen, the surgeon can then determine the amount or type of injury and, if necessary, take a biopsy specimen or repair or correct the problem. Arthroscopic surgery can be used to remove floating bits of cartilage and treat minor tears and other disorders. When the procedure is finished, the arthroscope is removed and the joint is irrigated. The site of the incision is bandaged. Arthroscopic surgery is used to diagnose and treat joint problems, most commonly in the knee, but also in the shoulder, elbow, ankle, wrist, and hip. Some of the most common joint problems seen with an arthroscope are: inflammation in the knee, shoulder, elbow, wrist, or ankle injuries to the shoulder (rotator cuff tendon tears, impingement syndrome, and recurrent dislocations), knee (cartilage tears, wearing down of or injury to the cartilage cushion, and anterior cruciate ligament tears with instability), and wrist (carpal tunnel syndrome) loose bodies of bone and/or cartilage in the knee, shoulder, elbow, ankle, or wrist Corrective arthroscopic surgery is performed with instruments that are inserted through additional incisions. Arthritis can sometimes be treated with arthroscopic surgery. Some problems are treated with a combination of arthroscopic and standard surgery. Also called arthroscopy, the procedure is performed in a hospital or outpatient surgical facility. The type of anesthesia (local, spinal, or general) and the length of the procedure depends on the joint operated on and the complexity of the suspected problem. Arthroscopic surgery rarely takes more than an hour. Most patients who have arthroscopic surgery are released that same day; some patients stay in the hospital overnight. Considered the most important orthopedic development in the 20th century, arthroscopic surgery is widely used. The use of arthroscopic surgery on famous athletes has been well publicized. It is estimated that 80% of orthopedic surgeons practice arthroscopic surgery. Arthroscopic surgery was initially a diagnostic tool used prior to open surgery, but as better instruments and techniques were developed, it began to be used to actually treat a variety of joint problems. New techniques currently under development are likely to lead to other joints being treated with arthroscopic surgery in the future. Recently, lasers were introduced in arthroscopic surgery and other new energy sources are being explored. Lasers and electromagnetic radiation can repair rather than resect injuries and may be more cost effective than instruments. Keep joints lubricated. Eat Jello. Post Comment Private Reply Ignore Thread Top • Page Up • Full Thread • Page Down • Bottom/Latest
#1. To: Tatarewicz (#0)
(Edited)
Examiner tabloid 8/18/14: 1/3 of knee replacements are "kneed-less", period, according to a study headed by Dr. Daniel Riddle of the VCU Dept of Physical Therapy. "Another 22 percent were labeled 'inconclusive'"..... these despised aren't the yellow rags they used to be. I've actually got a sub to the Globe because my hating partner gets the Examiner -- we swap, and I process each for real news like this right cheer.
A friend of mine (80) has worked physically hard all his life and both his knees gave out on him three years ago. He had both of them 'replaced' and now walks just fine, even able to work in short increments. Without them, he would be on crutches. U.S. Constitution - Article IV, Section 4: NO BORDERS + NO LAWS = NO COUNTRY
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