Surgery Often Doesn’t Work on Worn Out Knees

As they age, a lot of people have knee pain from osteoarthritis, and a lot of them undergo arthroscopic surgery to relieve it. But several studies find that the procedure offers neither improved function nor less pain for many.

A meta-analysis – one in which the data from many different studies are crunched – published in the journal CMAJ looked at how effective the surgery is to repair degenerative meniscal tears in patients with mild knee osteoarthritis.

Osteoarthritis is the most common form of arthritis. It occurs when cartilage and other tissues in the joint degenerate, leaving the bones with less cushioning and flexibility. Associated with middle and older age, it causes pain and stiffness, and is especially common in hip, knee and thumb joints. The meniscus is the cartilage, or shock absorber, in the knee joint.

As explained by, many patients with knee osteoarthritis (OA) also have degenerative meniscal tears. Previous studies have shown that arthroscopic surgery offers little benefit for people with severe arthritis, but what it does, or doesn’t do, for people with milder cases was unclear.

Arthroscopic surgery is less invasive than traditional surgery. It both diagnoses and treats problems. It uses smaller incisions and introduces a slender “scope” to view the damage and repair it. Traditional surgery involves larger incisions and more disruptive tools.

Arthroscopic surgery offers less risk for complication (such as infection) and a faster recovery time. But, of course, all surgery has some risk.

The CMJ researchers compared 805 surgical patients with people whose condition was managed without an operation. The surgery patients’ average age was 56, and they all had degenerative meniscal tears.

Knee function was measured on a scale for which 10 denoted “minimal important difference.” At six months after surgery, the patients’ average score was 5.6. Their measure for pain was even less.

The analysis involved seven trials. Five looked at function as long as two years after the procedure, and they found scores that did not meet the threshold of minimally important difference to patients.

Three trials considered long-term pain, and found no improvement in pain scores.

“The [minimally important difference] is the smallest effect that an informed patient would perceive as valuable enough to justify a change in therapeutic management when weighing the anticipated benefits against the possible harms of an intervention,” the researchers reported.

Although the researchers called for more studies to look at factors such as body mass index (if patients are overweight and, if so, to what degree) and how long individuals have suffered with symptoms, and to what degree, they still called this analysis “moderate evidence” of little benefit for surgery in mild OA.

“In the context of limited healthcare resources, clinicians must carefully select patients with degenerative meniscal pathology who would benefit from surgical intervention,” they wrote.

But because it’s not clear who those people are, it’s probably best to treat your knee OA, at least at first, with less invasive, rather than surgical, approaches. (See our blog from early this year, “Common Knee Surgery Should Probably Be a Last Resort.”) That means, possibly, physical therapy, weight loss (if necessary) and judicious use of over-the-counter anti-inflammatory drugs, if advised by your doctor.

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