Downsides of knee surgery 'may outweigh benefits for older patients'

New research has called into question the benefits of knee surgery for middle-aged or older patients with knee pain and degenerative disease.

Led by the University of Southern Denmark and published in the British Medical Journal, the study reviewed data from 18 previously-published research papers to determine benefits and harms of arthroscopic knee surgery involving partial meniscectomy, debridement or both in this age group.

The main analysis, combining the primary endpoints of the individual trials from three to 24 months postoperatively, showed a small difference in favour of interventions including arthroscopic surgery compared with control treatments for pain.

However, these benefits were described as being small and inconsequential, with any improvements in pain levels seen after six months failing to persist after a two-year follow-up.

On the other hand, the potential harms caused by this type of surgery were shown to be potentially serious and debilitating, with negative consequences including an elevated risk of symptomatic deep venous thrombosis, pulmonary embolism, infection and death.

The researchers concluded: "These findings do not support the practice of arthroscopic surgery for middle-aged or older patients with knee pain with or without signs of osteoarthritis."

This study was published by the British Medical Journal as part of its Too Much Medicine campaign, which aims to highlight the downsides of providing medical interventions in situations where treatment is unnecessary or actively harmful.

Currently, around 150,000 middle-aged and older adults with persistent knee pain undergo a knee arthroscopy in the UK each year.

A spokeswoman for Arthritis Research UK commented: "Arthroscopic surgery for people with knee osteoarthritis has long been discredited as an effective treatment by a series of research studies, yet it is still performed in the UK.

"Guidelines from the National Institute for Health and Clinical Excellence make it clear that this procedure should only be used to treat knee osteoarthritis in patients with a history of their knee locking or giving way.

"Hopefully this new evidence will finally put the matter to bed. People with knee osteoarthritis would benefit more from exercising to strengthen the quadriceps muscle that supports the knee joint, and to lose weight if they are too heavy."

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