Arthritis

Updated 16 February 2016

Knee surgery not needed for mild osteoarthritis

Middle-aged or older patients with mild or no osteoarthritis of the knee may not benefit from arthroscopic knee surgery.

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Each year more than four million such keyhole surgeries are performed worldwide for degenerative meniscus tears. A study, published in the Canadian Medical Association Journal (CMAJ), says middle-aged or older patients with mild or no osteoarthritis of the knee  may not benefit from the procedure of arthroscopic knee surgery.

Limited supporting evidence

Doctors need to be carefully weighing the costs and benefits when deciding who should undergo such surgery, says Dr. Moin Khan, principal investigator for the study and research fellow in orthopaedic surgery in the Michael G. DeGroote School of Medicine.

"This study shows that surgery should not be the initial option for middle-aged or older patients, as there is limited evidence supporting partial meniscectomy surgery for meniscus tears," he said. "Other treatments should be used first."

The meta-analysis review evaluated seven published randomized control trials between 1946 and 2014 on the success of arthroscopic partial meniscectomy in patients with no to mild osteoarthritis compared to non-operative treatments. The sample total was 811 knees in 805 patients with a mean age of 56 years.

Read: 
Lots of exercise in midlife may lead to osteoarthritis

In four trials, there was no short-term pain relief in the first six months after surgery for patients with some osteoarthritis; nor was there improvement in long-term function up to two years later in five trials.

Ineffective for long-term relief

The operation had become popular because as people age, the meniscus in the knee thins and becomes less flexible and more susceptible to tearing, causing pain and mechanical issues. This surgical procedure involves making small incisions to remove the torn fragments from the damaged meniscus. Although the surgery is minimally invasive, there may still be complications.

Previous studies showed that for patients with severe knee arthritis, arthroscopic knee surgery is not effective for long-term symptom relief.

Dr. Mohit Bhandari, professor and associate chair of research for McMaster's surgery department, and study co-investigator confirmed the study's conclusions.

"Arthroscopic debridement or washout of knee osteoarthritis has come under lots of scrutiny based upon trials that suggest patients get no benefit from the procedure. We're concerned that many surgeons worldwide may still be doing this procedure."

Read more: 

What is osteoarthritis? 

Symptoms of osteoarthritis 

Treatment of osteoarthritis 

 

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Professor Asgar Ali Kalla completed his MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 1975 at the University of Cape Town and his FRCP in 2003 in London. Professor Ali Kalla is the Isaac Albow Chair of Rheumatology at the University of Cape Town and also the Head of Division of Rheumatology at Groote Schuur Hospital. He has participated in a number of clinical trials for rheumatology and is active in community outreach. Prof Ali Kalla is an expert in Arthritis for Health24.

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