| Arthroscopic surgery to trim cartilage in the knee is a | | | | cartilage removed. The people who did not have |
| worthless procedure. I have seen many patients who | | | | surgery on their cartilage did better than the people |
| have had cartilage removed by surgeons for an | | | | who had some of their cartilage removed. |
| average charge of $5000 and then they must have a | | | | In the United States, more than 650,000 arthroscopic |
| knee replacement several years later. The surgeon | | | | procedures are performed each year, at a cost of |
| must know about the harm he is doing because he | | | | about $5,000 each. |
| has to see the same patients for followup when | | | | The knee is just two sticks held together by four |
| they require knee replacement surgery. | | | | bands called ligaments. Bones are soft, so the ends |
| A report in the New England Journal of Medicine (July | | | | of bones are covered with a hard gristle called |
| 11, 2002) shows that knee surgery to remove | | | | cartilage. Cartilage serves as a padding to protect the |
| cartilage is worse than doing nothing. The headline | | | | ends of bones. Once cartilage is broken, it can never |
| from Baylor Medical School, where the landmark | | | | heal. And once you break a small amount of cartilage |
| study was performed, is that "Study Finds Common | | | | in your knee, your knee cartilage can never fit |
| Knee Surgery No Better Than Placebo." Patients with | | | | together properly, and every time you put force on |
| osteoarthritis of the knee who underwent placebo | | | | the knee, you break off more cartilage. |
| arthroscopic surgery were just as likely to report pain | | | | When surgeons remove cartilage, they leave less |
| relief as those who received the real procedure. The | | | | cartilage than the person had before the surgery. |
| researchers say their results challenge the usefulness | | | | Eventually the knee joint runs out of cartilage and |
| of one of the most common surgical procedures | | | | when bone rubs on bone, it hurts all the time and a |
| performed for osteoarthritis of the knee. Lead | | | | peson must have a knee replacement just to be able |
| investigator Dr. Elda P. Way states, "The fact that | | | | to sleep at night. Surgery to remove cartilage just |
| the effectiveness of arthroscopic lavage or | | | | hastens knee replacement. On the other hand, |
| debridement in patients with osteoarthritis of the | | | | doctors can replace torn ligaments, which stabilizes |
| knee is no greater than that of placebo surgery | | | | the knee joint. They can also remove a loose piece |
| makes us question whether the one billion plus dollars | | | | of cartilage that is blocking the movement of the |
| spent on these procedures might not be put to | | | | joint. People with loose cartilage have sudden locking |
| better use," | | | | of the knee when they walk or the cannot fully |
| In the study, 180 patients with knee pain were | | | | straighten or bend their knees. |
| randomized into three groups. One group received | | | | As a result of this study and my own impression |
| debridement, in which worn, torn, or loose cartilage is | | | | from treating hundreds of damaged knees, I |
| cut away and removed with the aid of a pencil-thin | | | | recommend that you do not get knee surgery unless |
| viewing tube called an arthroscope. The second group | | | | you have a torn ligament that needs to be repaired |
| underwent arthroscopic lavage, in which loose | | | | or you have sudden locking of the knee during |
| cartilage is flushed out. The third group underwent | | | | walking or you cannot fully straighten or bend you |
| simulated arthroscopic surgery; small incisions were | | | | knee. Otherwise surgery is likely to hasten your need |
| made, but no instruments were inserted and no | | | | for another major surgery, knee replacement. |