Knee surgery 'should not be used to treat degenerative knee disease'
Knee arthroscopy should not be considered a suitable treatment option for the vast majority of patients with degenerative knee disease, according to experts.
An international panel, led by Reed Siemieniuk at McMaster University in Canada, has reviewed the available evidence and come to a firm conclusion that surgery does not offer any substantial benefits for these patients, despite most guidance suggesting otherwise.
Why knee surgery may be unsuitable
Part of the British Medical Journal's Rapid Recommendations initiative, which aims to quickly generate trustworthy guidance for doctors based on the latest evidence, the research involved a systematic review of 25 available studies, as well as an analysis of patients' preferences.
It was found that arthroscopic knee surgery, which involves keyhole surgery to relieve pain and improve movement, does not on average result in lasting improvements on either count in almost all patients with degenerative knee disease.
Although some individuals see a certain amount of post-surgical improvement, this is often no different from the results that would have been yielded by exercise therapy or other interventions, while the physical stress and lengthy recovery times associated with surgery were cited as important downsides.
Contradicting the current guidance
These recommendations come in spite of the fact that most guidelines support the use of arthroscopy in many groups of patients, including those with meniscal tears, patients who have experienced a sudden onset of symptoms, or people with mild to moderate difficulties with knee movement.
As such, these findings aim to challenge the commonly-accepted wisdom, pointing out that not only is surgery largely unnecessary regardless of whether patients have signs of osteoarthritis, but also that it cannot be considered cost-effective from an economic standpoint.
The researchers concluded: "We make a strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease, based on linked systematic reviews; further research is unlikely to alter this recommendation."
Arthritis Research UK's view
Professor Mark Wilkinson, Arthritis Research UK spokesperson and professor of orthopaedics at the University of Sheffield, said: "Degenerative arthritis is a group of conditions where the main problem is damage to the cartilage that covers the ends of the bones. Painful and debilitating degenerative knee arthritis affects around four million people in the UK.
"Previous studies have shown that knee arthroscopy is not recommended for the symptoms of pain and loss of function for people with degenerative knee arthritis. People with mechanical symptoms, such as locked knee, are more likely to benefit for this type of surgery; current guidelines support this.
"Anyone with pain and loss of function in their knee joints will find benefit from lifestyle modification, exercise, physiotherapy, suitable pain medication or joint replacement when non-surgical treatment becomes no longer effective."