Fake knee op 'as good as surgery'

Surgery is used to relieve pain

Major doubt has been cast on the benefits of a common operation carried out on people with osteoarthritis of the knee.

A US study has found that the procedure produced no better results than dummy surgery where patients were led to believe that they had undergone treatment when they had not.

The health care industry should rethink how to test whether surgical procedures are more efficacious than a placebo

Dr Nelda Wray

The patients who underwent placebo arthroscopic surgery were just as likely to report pain relief as those who underwent the real thing.

Researchers at Baylor College of Medicine say their findings pose a serious question over the true benefits of procedure that is one of the most common treatments for osteoarthritis of the knee.

Different groups

In the study, 180 patients with knee pain received one of three types of treatment:

• debridement, in which worn, torn, or loose cartilage is cut away and removed with the aid of a pencil-thin viewing tube called an arthroscope
• arthroscopic lavage, in which the bad cartilage is flushed out.
• simulated arthroscopic surgery in which small incisions were made, but no instruments were inserted and no cartilage removed

During two years of follow-up, patients in all three groups reported moderate improvements in pain and ability to function.

However, neither of the intervention groups reported less pain or better function than the placebo group.

Indeed, the placebo patients reported better outcomes than the debridement patients at certain points during follow-up.

Throughout the two years, the patients were unaware of whether they had received real or placebo surgery.

We shouldn't jump to the immediate conclusion that arthroscopy is a waste of time

Arthritis Research Campaign

Osteoarthritis, a degenerative joint disease, is the most common form of arthritis.

Symptoms include pain, stiffness, and swelling. Treatment typically involves pain-relieving and anti-inflammatory drugs, along with heat-therapy and exercise.

Surgery is undertaken if these treatments fail to work.

Lead researcher Dr Nelda Wray said: "The fact that the effectiveness of arthroscopic lavage or debridement in patients with osteoarthritis of the knee is no greater than that of placebo surgery makes us question whether the dollars spent on these procedures might not be put to better use.

"This study has important policy implications.

"The health care industry should rethink how to test whether surgical procedures, done purely for the relief of subjective symptoms, are more efficacious than a placebo."

Surprise

Dr Nelda Way says health policy should be questioned

A spokeswoman for the Arthritis Research Campaign said: "The results of this study are surprising, as it is widely known and accepted that washing out damaged knee joints with saline solution has a therapeutic effect because it washes out inflammatory agents in the joint fluid.

"The study doesn't say how old the patients were, or how bad their arthritis was, which could have been a contributory factor in producing such surprising results.

"This would appear to show that the power of the placebo is even greater than we already thought, but this is only one study, and we shouldn't jump to the immediate conclusion that arthroscopy is a waste of time."

The research is published in the New England Journal of Medicine.