An editorial by Head of NDORMS, Professor Andrew Carr published this week in The BMJ argues we should be doing far less knee surgeries as the procedure presents no real benefit to middle aged or older patients with persistent knee pain.
A linked paper in the same issue of The BMJ adds substantially to the debate by systematically reviewing all the evidence on the benefits and harms of arthroscopic knee surgery – a type of keyhole surgery – for middle aged and older adults with knee pain and degenerative knee disease. This study concluded that the benefit of surgery for these patients is inconsequential and potentially harmful. They say the benefit is “markedly smaller than that seen for exercise therapy” and their findings do not support surgery as a treatment for knee osteoarthritis.
Both articles are part of The BMJ’s Too Much Medicine campaign - to highlight the threat to human health and the waste of resources caused by unnecessary care.
Over 700,000 knee arthroscopies (a type of keyhole surgery) are carried out in the USA and 150,000 in the UK each year on middle aged and older adults with persistent knee pain. Yet the evidence for arthroscopic surgery is known to be weak, with all but one published trials showing no added benefit for surgery over control treatment.
“It is difficult to support or justify a procedure with the potential for serious harm, even if it is rare, when that procedure offers patients no more benefit than placebo,” argues Professor Andrew Carr. “With rates of surgery at their current level, a substantial number of lives could be saved and deep vein thrombosis prevented each year if this treatment were to be discontinued or diminished”.
Professor Carr believes “we may be close to a tipping point” where the weight of evidence against arthroscopic knee surgery for pain is enough to overcome concerns about the quality of studies, bias and vested interests. When that point is reached, he concludes, “we should expect a swift reversal of established practice.”