VA Study claims some knee surgery unwarranted

[Gimpy]

VA Study Questions Common Knee Surgery July 10, 2002
VA Study Questions Common Knee Surgery July 10, 2002

(EXCERPT) WASHINGTON ? Arthroscopic surgery for osteoarthritis of the
knee has been called into question by researchers from the Department
of Veterans Affairs (VA).

"This is the latest example of VA researchers benefiting all
Americans, not just veterans," said Secretary of Veterans Affairs
Anthony J. Principi. "I am very proud of the leadership role our
researchers continue to play in improving health care."

The research found that patients who underwent "placebo" arthroscopic
surgery for osteoarthritis of the knee were just as likely to report
pain relief as those who received the real procedure. This is one of
the most common surgical procedures for osteoarthritis of the knee.

The research was done by VA and the Baylor College of Medicine in
Houston. The results were published in the July 11 New England Journal
of Medicine.

In the study, 180 patients with knee pain were randomly divided into
three groups. One group received surgery in which worn, torn, or loose
cartilage was cut away and removed with the aid of a pencil-thin
viewing tube called an arthroscope. The second group underwent
arthroscopic lavage, in which the bad cartilage was flushed out. The
third group underwent simulated arthroscopic surgery in which small
incisions were made, but no instruments were inserted and no cartilage
removed.

All patients were aware at the beginning of the study that some would
not receive actual surgery.

During two years of follow-up exams, patients in all three groups
reported moderate improvements in pain and ability to function.
However, patients receiving "placebo" surgery reported the same
decrease in pain and improvement in function as the other two groups.
In fact, the placebo patients reported better outcomes at certain
points during follow-up.

"These VA research results cast doubt on the benefit of this common
procedure," said Dr. Jack Feussner, chief VA research and development
officer. "The results have implications for the quality, safety, and
costs of medcial care, for VA and the rest of the nation."

Osteoarthritis, a degenerative joint disease, is the most common form
of arthritis, and typically occurs in the knee. Symptoms include pain,
stiffness, and inflammation. Treatment typically involves
pain-relieving medicine and anti-inflammatory drugs, along with
heat-therapy and exercise. When these fail, surgery is often
recommended.

In the United States, it is estimated that more than $3 billion is
spent annually on 650,000 arthroscopic procedures of the knee, many
for arthritis. An individual procedure typically costs $5,000.

http://www.va.gov/opa/pressrel/Pres...rnet.cfm?id=476

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[sfc_darrel]

In this case, researchers convinced patients they had had surgery without subjecting them to more than minimal risks. The 180 participants did not know until the end of the two-year study which treatment they received, but they were told in advance that they might not get real knee surgery and had to write out a statement showing that they understood. Forty-four percent of patients who were invited to participate refused, said Baylor ethicist Baruch Brody.

``We were happy about that,'' he said. ``It was real evidence that people were understanding. ... If the refusal rate had gotten too low, we were going to stop the trial.''

The study's results are ``compelling'' and should encourage similar tests of other popular operations for subjective symptoms such as pain, said Carolyn Clancy, acting director of the federal Agency for Health Care Research and Quality. Such research can save lives and help other patients ``avoid risks of surgery that's not actually doing a lot,'' she said.

The study tested two kinds of arthroscopic knee surgery for osteoarthritis. Both are done through small incisions by a surgeon who views the inside of the joint through an instrument called an arthroscope. In one type, known as lavage, the surgeon uses large quantities of saline to wash particles and inflammatory enzymes out of the joint. In the other, called debridement, the surgeon also uses instruments to smooth out rough joint cartilage and remove loose debris.

Study participants were randomly assigned to the three treatments. Those receiving real surgery had general anesthesia. Those in the placebo group received an intravenous drug to make them sleep and a local anesthetic for the skin incisions. Moseley kept each patient in the operating room for the normal length of an operation, called for various instruments and moved the leg around as he would during the real procedure.

When questioned about knee pain, arthritis pain and total body pain during the two- year follow-up period, all patients reported the same degree of improvement. On objective tests measuring their ability to walk and climb stairs, there was no significant improvement in any group.

http://tampatrib.com/MGAI6T24I3D.html

[colmurph]

They'd find out that about 60% of the operations performed these days accomplish little more than paying for the surgeon's new sports car. Just like an orthodontist looking into a kid's mouth, he doesn't see misaligned teeth, he sees GOLD.

[Keith_Hixson]

Twisted my knee bad this March. Doc said the pictures look like little or no permanent damage. He said it might heal naturally in a few weeks but often inflamation in the knee takes six months to nine months to go away (like tennis elbow in the Arm). He said you'll have severe pain until at least July in most cases. He was right! It is starting to heal and feels almost normal but it was a long haul. Never lost any strength, just had a lot pain on movement. He said he could do surgery but thought it was unneccessary. It seems he was right. Missed out on a whole spring of golf and fly fishing.

Keith