| Considering arthroscopic surgery for that persistent | | | | end-stage osteoarthritis. |
| arthritic knee pain, that just won't leave you alone? | | | | In my years of orthopaedic practice, it was my |
| Maybe you should think again. And I'm a former knee | | | | experience that if a patient had full-blown arthritis, |
| surgeon, telling you this. The truth is, you may do | | | | there was little reason to arthroscope them, UNLESS |
| just as well with conventional, alternative, or | | | | they had a sudden increase in very specific joint line |
| complementary conservative treatments and save | | | | pain, giving way, or locking (so-called mechanical |
| yourself pain, risk and money. | | | | symptoms) that suggested a displaced, or entrapped |
| In a study published in the September 11th, 2008 | | | | tear of the meniscus, or a fulminant synovitis |
| issue of The New England Journal of Medicine, a | | | | (inflamed lining membrane of the knee, as in |
| group of Canadian researchers, from the Fowler | | | | Rheumatoid Arthritis) that would not respond to |
| Kennedy Sport Medicine Center of the University of | | | | medical treatment, or needed relief, but were a poor |
| Western Ontario, compared two groups of patients | | | | risk for major joint surgery, like a total knee |
| with known moderate to severe osteoarthritis. 178 | | | | replacement. |
| patients were randomly assigned to receive either | | | | I used arthroscopic surgery for very specific |
| surgery ( arthroscopic lavage - a washout of the | | | | mechanical or synovial overgrowth or inflammatory |
| joint, by saline- and debridement-essentially a "clean | | | | problems, NOT just as a "catch-all" treatment for |
| out" of the joint), followed by optimized physical and | | | | arthritis pain. I always believed in a conservative |
| medical therapy, or non-surgical treatment, ie., | | | | approach first, letting the knee itself declare if and |
| physical and medical therapy alone. After comparing | | | | when it was ready for a major surgery, by failing to |
| the results of each group at two years, it was | | | | improve. I STILL DO. |
| objectively documented that patients treated by | | | | There are times when surgery is needed. To deny |
| arthroscopy, medication and P.T. did no better than | | | | this, or make frankly stupid statements that "surgery |
| those that had no surgery and were treated only | | | | is NEVER warranted," is to deny the facts. But |
| with conservative measures. | | | | surgery should be the last, or the best option - not |
| Their conclusion was that arthroscopic surgery of the | | | | the first line of defense. In short, when it comes to |
| knee for osteoarthritis (degenerative or "wear and | | | | arthritis, as with any other medical problem, you want |
| tear" arthritis) "provides no additional benefit to | | | | to AVOID the UNNECESSARY SURGERY. |
| optimized physical and medical therapy." In other | | | | So, what to do? There are a number of things that |
| words, there was NO DIFFERENCE between those | | | | you can control that will give you relief. First, lose |
| that were treated surgically and those who were | | | | weight. Every pound you lose reduces stress across |
| NOT. This, of course, suggests that surgery done | | | | the knee by 3-4 pounds, even higher if you climb |
| strictly for arthritis pain is not warranted. | | | | stairs or attempt to run. Don't run, jump or do |
| Their study confirms the findings of an earlier study | | | | anything that involves impact to your knee. |
| done in 2002 that compared arthroscopic surgery | | | | Avoid red meat-it's a source of arachidonic acid, a |
| with sham surgery (ie., skin incisions were made that | | | | chemical precursor of inflammatory chemicals, like |
| mimicked true arthroscopic portals, but instruments | | | | prostaglandins, that stimulate pain receptors. |
| were not introduced into the joint). Short term pain | | | | OTC pain relievers may be helpful, but MUST be |
| relief of pain in BOTH groups (ie., real surgery and | | | | taken with FOOD, to protect your stomach from the |
| sham or fake surgery) was the SAME! This result | | | | side effects of NSAID's (like Advil or Aleve), and |
| was attributed to a placebo effect in the sham | | | | should be avoided if you have ulcers or acid reflux. |
| surgery group. | | | | Natural remedies, like fish oil, Lyprinol, willow bark, |
| This result was so impressive that Medicare used it | | | | ginger, and devil's claw are effective and may also be |
| as a basis for their determination to refuse to pay | | | | helpful. |
| for arthroscopy for the treatment of arthritis pain. | | | | But the best long term method to relieve pain and |
| And this study was a reinforcement of an even | | | | restore function is consistent low impact exercise. |
| earlier study that compared arthroscopic surgery with | | | | Exercises that stretch and strengthen the muscles |
| merely lavage (injecting and extracting saline, or salt | | | | around the knee not only provide support and |
| water, into and out of the knee joint, to wash it | | | | maintain motion of the joint, but stimulate endorphins |
| out). Here, too, there was NO DIFFERENCE between | | | | and intrinsic growth hormone release, both of which |
| the surgery and the wash-out groups. | | | | help to relieve the pain of arthritis. You can't cure |
| So, this most recent study is just more evidence of | | | | arthritis, but with these and other non-operative |
| what you know instinctively- letting the body heal | | | | measures you can relieve your pain and delay |
| itself is the best course, except in advanced, or | | | | surgery, perhaps indefinitely. |