WASHINGTON, June 18 (UPI) -- More than 700,000 knee arthroscopies are done in the United States and 150,000 in the United Kingdom annually, however studies have shown that many of those surgeries performed on middle-aged and older patients often have little or no long-term benefit over non-surgical treatments.
Based on a meta-analysis of nine studies, researchers concluded that many knee arthroscopies are unnecessary and could cause more harm than help.
"Supporting or justifying a procedure with the potential for serious harm, even if this is rare, is difficult when that procedure offers patients no more benefit than a placebo," wrote Dr. Andy Carr, a professor of Orthopedic Surgery at the University of Oxford, in an editorial for the British Medical Journal.
Researchers in the study selected nine trials conducted since 2000 that assessed the benefits of arthroscopic knee surgery for middle-aged and older patients, each of which tracked the patients for between 3 and 24 months after surgery for pain levels and changes physical function. Overall, studies showed a 2.4 percent improvement in pain and no change in physical function for patients who'd had surgery.
Carr notes that for many patients, the measure of success is pain, which is subjective. As a result, the difference between the reported results of actual surgery versus placebo surgery are minimal, he said, and don't justify the procedure's risks, which can include serious adverse events such as deep venous thrombosis, infection, pulmonary embolus and death
"Uncertainty thus exists about the benefit of arthroscopic surgery including meniscus resection for these patients," researchers wrote in the study, continuing that "many specialists are convinced of the benefits of the procedure from their own experience and several recent reports show an increase, or no decrease, in the incidence of arthroscopic knee surgery with meniscus resection during the past decade."
Carr goes on to state that surgeon dedication to the procedure is strong enough that doctors suggested patients participating in placebo trials "may not be of entirely sound mind," and questioned the ethics of the use of placebo surgery overall.
"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 the studies, confirmation bias, and vested interests," Carr wrote. "When that point is reached, we should anticipate a swift reversal of established practice."
The study is published in the British Medical Journal.