By Christine Sadlowski
Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM
Arthroscopic surgery for knee pain in middle-aged and older patients is not more beneficial than standard care beyond 6 months and is associated with harms, a BMJ meta-analysis shows.
In nine studies, almost 1300 patients were randomized to partial meniscectomy, debridement, or both versus control treatments (e.g., placebo surgery, exercise). Pain was marginally better at 3 and 6 months after surgery but not at later times, up to 2 years (overall effect size, 0.14 — corresponding to a 2.4-mm benefit on a 100-mm visual analogue scale). Among subgroups, including patients with radiographic osteoarthritis, results were similar to the main findings.
Analysis of two randomized and seven observational studies showed that adverse effects of surgery were not negligible: deep vein thrombosis occurred in 4 per 1000 surgeries, infection in 2, pulmonary embolism in 1, and death in 1.
The authors conclude, “Available evidence supports the reversal of a common medical practice.”
LINK(S):
BMJ article (Free)
BMJ editorial (Subscription required)
Background: NEJM Journal Watch General Medicine 2014 top story on conservative treatment for chronic orthopedic pain (Your NEJM Journal Watch subscription required)