The knee is a complex joint, often considered the most complex in the human body. It also bears the body’s weight and wears out relatively quickly. It is no wonder that a quarter of people suffer from degenerative knee disease after the age of 50. Arthroscopic knee surgery is a common option for the mitigation of degenerative knee pain, however, growing evidence suggests that the method is not as effective as we have previously thought.
What Is Knee Arthroscopy
Arthroscopic knee surgery is a surgical procedure that allows physicians to assess the knee joint in a less-invasive manner. Traditional knee surgery requires a large incision before helpful diagnostic information can be ascertained. Knee arthroscopy allows surgeons to make small incisions with specialized instruments, often reducing patient recovery times drastically.
“Arthroscopy” refers to the arthroscope inserted for the duration of the surgery. It is a small tube containing a system of lenses, a light, and a small video camera. With the arthroscope inside the knee, a physician can use the images relayed to video monitors to perform minute surgery on the joint. More than two million such surgeries are performed each year throughout the world.
Is Arthroscopic Knee Surgery Worth It?
The decision to undergo surgery is based on many different factors, including immediacy of need for treatment, the risks of the procedure, other treatment options available, and the patient’s own comfort levels of undergoing surgery. The dangers of arthroscopic knee surgery, in addition to the sheer burden of undergoing knee surgery, can be dramatic.
While the procedure is often purported to have a success rate over 90%, every individual case is different, and like any medical procedure, there can be complications. A surgeon assesses each case individually before going ahead, but unforeseen problems can arise. These may include infection and clotting, both of which lead to other major health challenges, and even nerve damage, which can negatively affect a patient’s lifestyle for years.
Because the surgery requires such small incisions and utilizes such fine tools, recovery time for arthroscopic surgery is often markedly reduced compared to other knee surgeries. While patients do feel residual pain, stiffness, or swelling as their knees recover, it is, again, comparatively less.
When a physician says that a procedure has a 90% success rate, that number is highly encouraging. If the doctor quotes a figure closer to 15%, the appeal is dramatically reduced. Unfortunately, though initial pain relief after arthroscopic knee surgery is almost guaranteed, depending on the underlying cause of knee trouble, the results may not last.
A study conducted by Siemieniuk, et al. and published in the British Journal of Sports Medicine in March 2018 found that improvements initially experienced by knee arthroscopy patients lasted at least three months in less than 15% of participants. For none of the participants was the benefit sustained for one year. While the incidence of complications is well-cited, there is no evidence of important lasting benefit.
How can this be? How can the values of initial success and lasting result differ so dramatically? While many people see marked improvement after arthroscopic knee surgery, the authors of the study suggest that improvements may be more associated with the natural course of degenerative knee arthritis, co-interventions, or even placebo effects than previously considered.
Unfortunately, that is the nature of degenerative knee disease. It is a chronic condition in which symptoms are known to fluctuate. While for the majority of patients, pain levels decrease over time with regular medical care and prescribed physical therapy, it can be difficult to wade through the process when pain levels are high. However, doing so and delaying knee replacement is encouraged when possible. Those for whom knee arthroscopy is truly beneficial are those who suffer from locked knees.
Alternative Treatment to Knee Arthroscopy
The study by Siemieniuk, et al. adds to the body of evidence suggesting that the benefits of knee arthroscopy simply do not outweigh the risks and recovery process. Though recovery times are shorter and the process is less painful than traditional knee surgery, for most cases, the need for surgery at all can be avoided by other non-invasive means.
Depending on the underlying problem in a patient’s knees, knee arthroscopy has proven to be no more effective than exercise therapy, and when the surgical burden, postoperative limitations, and rare serious adverse effects associated with arthroscopic knee surgery are weighed, the disheartening lack of lasting results makes physical therapy all the more appealing. Consult with both your general physician and chiropractor to know which treatment method is best for your knees.