Knee ops ‘no better than painkillers’

Is keyhole success all in the mind?

MANY knee operations conducted by keyhole surgery are no more effective than painkillers, according to a leading surgeon.

Professor andrew Carr said the success of such procedures was often down to the ‘placebo effect’, where patients feel better as a result of their belief in the treatment.

He warned some who had keyhole knee surgery suffered serious complications such as infections or pulmonary embolisms. ‘Some people die,’ he said.

‘i don’t think we should be doing operations where the entire effect is placebo,’ the founder and director of the University of Oxford institute of Musculoskeletal Sciences told the Cheltenham Science Festival.

Professor Carr was discussing a study comparing patients who underwent keyhole surgery with those who had simply had an anaesthetic and incision but no surgical procedure.

The research by scientists at lund University in Sweden involved a systematic review of previous studies of arthroscopy used to treat pain caused by tears in cartilage or arthritis.

The procedure involves using a device called an arthroscope, a thin, metal tube with a light source and a camera inserted via a small incision.

This allows a detailed examination and sometimes treatment by a surgeon seeing the inside of the knee on a video screen.

The Swedish researchers found that both arthroscopy and exercise improved knee pain, although the surgical procedure was slightly better.

However, they said the improvement was about the equivalent of using a painkiller such as paracetamol. They found that around one in 1,000 died a result of the procedure.

also speaking at the science festival, psychologist Felicity Bishop said the placebo effect can be used without surgery by

‘Losing some of the effectiveness’

doctors to improve treatment. ‘Research suggests that doctors who encourage their patients to be more confident and optimistic about their treatment and do so in an empathic, sympathetic way can indeed increase the effectiveness of treatment,’ she added.

Professor andrew george, an immunologist and deputy vicechancellor of Brunel University, said that in the 18th century doctors worked with a huge sense of drama.

‘They actually bigged it up so it had the placebo effect,’ he said.

‘You could argue that we’ve gone to the other extreme, where we’re trying to almost de-emphasise the drama, make it routine, so going to the doctor seems like going to the local supermarket.

‘it may be that actually, we are losing some of the effectiveness by taking the magic out of it.’

He added that conventional doctors might learn from homeopaths because their consultations had a placebo effect.

Professor Carr said much of the placebo effect was a result of offering good care, giving patients detailed explanations and lots of information.

‘if we can adopt those across other areas in medicine we should do that to get better effects,’ he told the festival.

He added that placebo treatment worked only for ‘appropriate conditions’, but there were an ‘enormous number of those conditions and disabilities’.

The NHS recommends arthroscopy when arthritis makes the knee lock up, and says that fewer than one in 100 patients develop serious complications.