Knee Arthritis Surgery Fails to Outdo Placebo

A popular surgical procedure performed on thousands of patients suffering from arthritis of the knee may not be so effective after all. New research by the Veterans Affairs Medical Center in Houston, Texas contends that arthroscopic knee surgery for arthritis is a sham operation that is no better than a placebo treatment.
In a recent study, two groups of patients were put through one of two types of arthroscopic knee surgery, lavage or debridement. The former involves the flushing of joints with saline; the latter, the scraping of joint tissue. The goal of both is to remove unwanted inflammatory substances in the knee. A third group underwent a mock surgery. Since the study was blind, the subjects did not know to which of the three groups they belonged—all of them bore incision marks that commemorated their visit to the hospital.
For two years after the operation, researchers monitored the patients' progress, giving them questionnaires and testing their motor abilities. Those who did not receive either surgery recuperated just as well as those who received one or the other, in terms of pain and knee function.
The researchers did not mandate any formal physical rehabilitation after the surgery, or include it in the study. They only asked the patients to use ice and crutches to keep the swelling down for the first week.
Afterwards, patients performed routine daily activities as they were able to, given their post-surgical condition. Arthroscopic knee surgery is performed 300,000 times a year and costs $5000. Perhaps publication of this new finding in the July 11, 2002 issue of the New England Journal of Medicine will lead to the procedure being used only for arthritis-unrelated knee injuries, such as damaged meniscuses (cartilage tissues cushioning jointed bones) or torn ligaments, for which the surgery has been shown to be effective.