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(Reuters Health) – Arthroscopic knee surgery is becoming a less common treatment in adults with torn cartilage or painful arthritis, as a growing body of evidence shows little benefit from these operations, suggests a American study.
The researchers examined data on all surgeries performed on patients aged 18 and over in Florida from 2002 to 2015, including a total of 868,482 knee arthroscopic procedures. Overall, the rates of these transactions decreased by 23% during the period under review, with more pronounced declines after 2008.
Many experts believe that doctors do not change the way they treat patients when studies show that these treatments do not work, and knee arthroscopy is often cited as an example, according to study author David Howard from Emory University in Atlanta.
"There was evidence that the use of arthroscopy was declining, but this study shows that the decline was significant and was sustained," Howard said by email. "I think patients can be reassured that doctors have responded to the evidence."
During this operation, a surgeon makes a small incision in the knee and inserts a tiny camera called arthroscope to see the inside of the joint, locate and diagnose the problem and guide the repairs.
Although not invasive, it is not without risk. Patients receive anesthesia which, in any surgery, can lead to complications such as allergic reactions or breathing difficulties. In addition, this specific knee procedure can damage the knee or cause blood clots in the leg.
Many studies have shown that knee arthroscopy is no better than nonoperative treatments for conditions such as arthritis, torn cartilage and knee pain, notes Howard in JAMA Internal Medicine. But to date, the evidence has not given a clear picture of how physicians and patients avoid operations.
Between 2002 and 2015, knee arthroscopy rates in Florida decreased from 449 procedures per 100,000 adults in the population to 345 procedures per 100,000 adults, according to the current study.
The declines were most pronounced after 2008, when a second major trial was published, which did not reveal a difference between surgery and "medical care".
These surgical declines occurred as the prevalence of knee osteoarthritis among US adults more than doubled from 6.6% in 1999 to 14.3% in 2014, writes Howard.
The study was not a controlled experiment designed to prove what factors might have influenced the declines in these surgeries or if, and how, patients could have different health effects. And he only included Florida data.
However, the findings suggest that physicians and patients are receiving the message that these operations are not the best approach for wear that contributes to knee pain with age, said Andrew Carr, researcher at the University of Oxford in the United Kingdom. was not involved in the study.
"Rest and time are often very helpful," said Carr by email. "If symptoms persist, other treatments, including physical therapy and the use of anti-inflammatory drugs, may be beneficial."
Jonas Bloch Thorlund, a researcher at the University of Southern Denmark, did not participate in the study.
"There is still room for improvement," Thorlund said by email.
SOURCE: JAMA Internal Medicine bit.ly/2xBHzt9, online September 24, 2018.
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