Keyhole knee ops ‘pointless for joint pain’

150,000 have procedure each year

KEYHoLE knee operations on patients with a common form of arthritis should stop as they do little to help, researchers warn today.

Arthroscopic surgery – a minor procedure to treat arthritic knees and torn cartilage – has been ‘oversold as a cure-all for knee pain’, they say.

But a review concludes that ‘ almost all’ patients with degenerative knee problems would fail to benefit from the technique.

A report in the British Medical Journal makes a ‘ strong recommendation’ against using the procedure for patients with osteoarthritis. Further research is ‘unlikely’ to alter this view, it adds.

More than 150,000 Britons have arthroscopic keyhole surgery to their knees every year.

Most hope to mend sports injuries or torn cartilage but many have the operation for osteoarthritis of the knee, which affects around 4million patients.

The review by an international panel of bone surgeons, physiotherapists, clinicians and patients assesses 25 studies.

The panel concludes the treatment offers no ‘important benefits’ as it neither reduces pain nor improves function and mobility. They say it was no better after two years than ‘ conservative management’, including exercise and painkillers.

The team writes: ‘We make a strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease based on linked systematic reviews.

‘Further research is unlikely to alter this recommendation.’

The use of keyhole surgery on the knees has rapidly expanded since it was first carried out in Britain in the 1980s. Surgeons put a tiny camera at the end of a tube through a slit in the skin while they operate through one or two other small incisions.

The procedure usually takes less than an hour and patients often go home the same day. Its simplicity means it has boomed and is often used for frail or elderly patients.

But in recent years evidence has suggested it may have been overused and many patients would have done better with exercise and rest. Last year another study in the BMJ found the operation was no better than exercise for treating a meniscus tear, the cartilage between the knee joints.

Professor Mark Wilkinson, for Arthritis Research UK and an expert in orthopaedics at the University of Sheffield, said keyhole surgery could help those with mechanical problems, such as locked knee, but not arthritis.

‘Degenerative arthritis is a group of conditions where the main problem is damage to the cartilage which covers the ends of the bones,’ he said.

‘Previous studies have shown that knee arthroscopy is not recommended for the symptoms of pain and loss of func- tion for people with degenerative knee arthritis.

‘They will benefit from lifestyle modification, exercise, physiotherapy, pain medication or joint replacement.’

Scarlett McNally, of the Royal College of Surgeons, said that orthopaedic surgeons are ‘already moving away’ from knee arthroscopy.

They only consider it ‘as a suitable course of action for patients who have issues with their knee moving past a certain point or with it giving way unexpectedly’.

She added: ‘ Surgeons also only offer it to patients who have not responded well to nonsurgical treatment after at least three months.’

‘They will benefit from exercise’