Considering arthroscopic surgery for that persistent arthritic knee pain that just won’t leave you alone? Maybe you should think again. And I’m a former knee surgeon, telling you this. The truth is, you may do just as well with conventional, alternative, or complementary conservative treatments and save yourself pain, risk, and money.

In a study published in the September 11th, 2008 issue of The New England Journal of Medicine, a group of Canadian researchers from the Fowler Kennedy Sport Medicine Center of the University of Western Ontario compared two groups of patients with known moderate to severe osteoarthritis.¹

One hundred seventy-eight (178) patients were randomly assigned to receive either surgery (arthroscopic lavage — a washout of the joint by saline and debridement — essentially a “clean out” of the joint), followed by optimized physical and medical therapy, or non-surgical treatment, i.e., physical and medical therapy alone.

After comparing the results of each group at two years, it was objectively documented that patients treated by arthoscopy, medication, and physical therapy did no better than those that had no surgery and were treated only with conservative measures.

Their conclusion was that arthroscopic surgery of the knee for osteoarthritis (degenerative or “wear and tear” arthritis) “provides no additional benefit to optimized physical and medical therapy.” In other words, there was NO DIFFERENCE between those who were treated surgically and those who were NOT. This, of course, suggests that surgery done strictly for arthritis pain is not warranted.

Their study confirms the findings of an earlier study done in 2002 that compared arthroscopic surgery with sham surgery (i.e., skin incisions were made that mimicked true arthroscopic portals, but instruments were not introduced into the joint).² Short term pain relief in BOTH groups (real surgery versus sham or fake surgery) was the SAME! This result was attributed to a placebo effect in the sham surgery group.

This result was so impressive that Medicare used it as a basis for their determination to refuse to pay for arthroscopy for the treatment of arthritis pain.

And this study was a reinforcement of an even earlier study that compared arthroscopic surgery with merely lavage (injecting and extracting saline or salt water into and out of the knee joint, to wash it out). Here, too, there was NO DIFFERENCE between the surgery and the wash-out groups.³

So this most recent study is just more evidence of what you know instinctively — letting the body heal itself is the best course, except in advanced or end-stage osteoarthritis.

In my years of practice, it was my experience that if a patient had full-blown arthritis, there was little reason to perform arthroscopy unless they had a sudden increase in very specific joint line pain or a joint giving way or locking (so-called mechanical symptoms).

That’s because these problems suggest a displaced or entrapped tear of joint cartilage or extreme synovitis(inflamed lining membrane of the knee, as in rheumatoid arthritis) that would not respond to less invasive medical treatment or call for  major joint surgery (like a total knee replacement).

But, there are times when surgery is needed. To deny this, or make frankly stupid statements that “;surgery is NEVER warranted,”; is to deny the facts.  Surgery however, should be the last, or the best option — not the first line of defense.  In short, when it comes to arthritis, as with any other medical problem, you want to AVOID the UNNECESSARY SURGERY.

So, what to do? There are a number of things that you can control that will give you relief:

• First, lose weight. Every pound you lose reduces stress across the knee by 3-4 pounds, even higher if you climb stairs or attempt to run. Don’t run, jump, or do anything that involves impact to your knee.
• Avoid red meat — it’s a source of arachidonic acid, a chemical precursor of inflammatory chemicals, like prostaglandins, that stimulate pain receptors.
• OTC pain relievers Advil or Aleve may be helpful, but must be taken with food to protect your stomach from the side effects.   These NSAIDs should be avoided if you have ulcers or acid reflux.
• Natural remedies like fish oil, lyprinol (a marine extract), willow bark, and devil’s claw are effective and may also be helpful.

But the best long-term method to relieve pain and restore function is consistent low impact exercise. Exercises that stretch and strengthen the muscles around the knee, not only provide support and maintain motion of the joint, but stimulate endorphins and intrinsic growth hormone release — both of which help to relieve the pain of arthritis.

You can’t cure arthritis, but with these and other non-operative measures, you can relieve your pain and delay surgery — perhaps indefinitely.

References

1. Kirkley, A.et al.  NEJM 359:1097-1107, Sept 11, 2008, Number 11.
2. Mosely, J.B. et al. NEJM 347:81-88, July 11, 2002, Number 2.
3. Kalunian, K.C. et al.  Osteoarthritis Cartilage 2000; 8:4, 12-8.

[Ed. Note: Dr. Bill is the online handle for William T. Stillwell, MD, FACS, FICS, FAAOS, FAANAOS, FAAPGS, a highly credentialed, board-certified orthopaedic surgical specialist, now President & CEO of Dr. Bill's Clinic, Inc. and author of How to Avoid  Knee Surgery. To learn more, click here.]

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