Approximately 25% of people older than 50 suffer from degenerative knee disease, and every year, nearly 800,000 knee replacements are performed in the United States alone. The knee is the most complicated joint in the human body, and because it supports the body’s weight while maintaining mobility, it is no real wonder that knees tend to wear out quickly. The most common treatment, especially in cases of degenerative knee arthritis or meniscal tears, is arthroscopic knee surgery. However, just because one solution is most common does not mean it is most effective.
What Is Arthroscopic Knee Surgery
Knee arthroscopy is evidence that medicine continues to evolve. The surgical procedure is less invasive than traditional knee surgery, allowing surgeons to make only minute incisions and still produce results. The incision is small, the tools used are small, and the use of an arthroscope allows the surgeon a clear picture of the inside of the joint with minimal damage to it.
An arthroscope is a small tube containing a light, a network of mirrors, and a small video camera. It sends images to video monitors, allowing the surgeon to see inside of the knee joint as he or she works. This minimizes the need for extensive incisions and probing.
The Recovery Process
Because arthroscopic knee surgery is less invasive than traditional knee surgery, the recovery process is usually less painful and lasts a shorter time. Patients can usually return to the activities they enjoy after six weeks and during that time have reduced pain, swelling, and joint stiffness. This is only the case if the surgery does not have complications.
The Risks
With any medical procedure, there is a risk of complications, and arthroscopic knee surgery is no exception. It involves opening the knee joint, exposing it to infection if the necessary precautions fail. Clotting and nerve damage can also follow, resulting in further medical difficulties down the line. If a patient experiences residual pain, swelling, or stiffness beyond what is typical of recovery, there is likely an underlying cause initiated or exacerbated by the surgery.
Comparing Knee Arthroscopy and Noninvasive Treatment
Arthroscopic knee surgery is one of the most common surgeries performed every year, with over two million performed across the world. The procedure has an over 90 percent success rate. However, a growing body of evidence suggests that though knee arthroscopy is highly effective for initial pain management, its results are not sustained, and the benefits of less invasive treatment may outweigh those of the surgery.
Siemieniuk, et al.
In a study published in the British Journal of Sports Medicine in March 2018, Siemieniuk, et al reviewed the benefits of arthroscopic knee surgery in comparison with 13 randomized trials for benefit outcomes (1,668 patients) in addition to 12 observational studies for complications (>1.8 million patients). The review panel included orthopedic surgeons, physiotherapists, epidemiologists, a general practitioner, and other medical professionals in addition to individuals with personal experience of degenerative knee disease.
Their research found that, while arthroscopic knee surgery was successful at the outset, securing initial pain relief for those with degenerative knee conditions, in fact, the results did not last. Fewer than 15% of those studied still saw small improvement three months after their surgery, and no improvement was sustained as long as a year.
Siemieniuk, et al attributed the majority of knee arthroscopy’s success to the natural course of degenerative knee disease, which by nature has fluctuating symptoms and pain levels. Other treatment methods and even placebo effects could also play a role. The only group for whom knee arthroscopy is definitively beneficial includes those with true locked knees, unable to fully extend them.
The conclusion of Siemieniuk, et al is that while there is no evidence of lasting benefits for knee arthroscopy, the risks and burden of recovery are well-documented. Potential benefits do not, therefore, outweigh the risk. Their recommendation is to delay knee replacement as long as possible and instead consult a physician for pain management strategies with more supported positive results.
Physical and Exercise Therapy
Knee pain tends to improve over time with regular medical care. Physical and exercise therapy provide a means to mitigate knee pain in a non-invasive manner. The extent of their effectiveness is directly related to the underlying cause of knee pain, being more effective for meniscus tears than for chronic conditions. In fact, the study in 2018 found that in cases of degenerative tears of the medial meniscus, knee arthroscopy provided no more relief than did exercise therapy.
Patients suffering from degenerative knee pain should consult with their primary physician and their chiropractor to know which treatment method is right for them. They should also be aware that the benefits of arthroscopic knee surgery do not outweigh the burden of recovery, postoperative limitations, and prospective risks of the procedure, and that a recovery from knee surgery usually includes physical and exercise therapy anyway. Nonsurgical treatment may be the most effective and lasting course to relief.
