Therapy vs. Surgery for Knee Osteoarthritis
By: Loren Kalm for Knee1
Researchers have concluded that arthroscopic surgery is equally effective as medicine and rehabilitation in treatment of osteoarthritis of the knee. Arthroscopic surgery has quickly become a common practice since its introduction to the medical community as an experimental procedure 30 years ago.
Osteoarthritis is a degenerative joint disease caused by excess wear and tear of cartilage that cushions the knee. Some causes can be continuous or traumatic impact through exercise, additional pressure put on the knees from obesity, or simply a genetic predisposition to cartilage deterioration. The end result is chronic pain and inflammation of the knee: symptoms which affect almost 21 million Americans including 60 percent of the population over the age of 65.
| Tips for Reducing the Pain and Severity of Knee Osteoarthritis |
Weight reduction: for every pound lost, your knees lose four pounds of pressure
Mechanical support: canes, braces, and walkers reduce the stress put on knees
Applying heat prior to exercise and a cold pack afterwards can alleviate swelling
Try low impact exercises such as swimming or using an elliptical machine
Pain medication including ibuprofen, capsaicin, or acetaminophen can reduce pain associated with arthritis
Two studies in the New England Journal of Medicine have shown that arthroscopic surgery of the knee provides no additional long-term benefits to osteoarthritic patients in comparison to medicine and rehabilitation and instead increases the risks and costs involved with surgery.
Doctors now believe that the practice will be on the decline in favor of physical therapy supplemented with anti-inflammatory and pain medication. Dr. Brian Feagan, co-author of the two-year study said, “There's going to be a swing in practice,” with regards to treatment of osteoarthritis in specific. Dr. Robert Marx, an orthopedic surgeon at the Hospital for Special Surgery in New York added, “If patients have severe arthritis that fails non-operative treatment, then they may benefit from a total knee replacement rather than arthroscopic surgery.”
Arthroscopic surgery is a minimally-invasive procedure, whereby a small incision is made in the knee, to extract cartilage fragments, calcium crystals, and other debris using a fluid injection and vacuum to wash the knee clean.
Experts note, however, that arthroscopic surgery should not be dismissed as a treatment altogether. Study co-author Dr. Bob Litchfield said, "Knee arthroscopy is still beneficial in many other conditions affecting the knee, such as meniscal repair and resection, and ligament reconstruction." These results may in turn have an affect on insurance agencies which may limit their coverage of arthroscopic knee surgery in general, despite its effectiveness in specific situations.