THE PROBLEM

Millions all over the world live with the pain and restricted movement that goes with osteoarthritis of the knee. Arthroscopy is a surgical treatment that is incredibly popular, and that's often claimed to relieve the pain.

THE PROCEDURE IN QUESTION 

The procedure is done as a day surgery and it involves the insertion in the knee of both a camera and surgical instruments through small incisions around the knee. These instruments are then used to remove loose fragments or partially detached pieces of the lining of the joint. Doctors often refer to it as "a clean up" or "smoothing over" of the joint, involving removal of loose fragments.

THE EVIDENCE  

There is however little evidence that arthroscopy of the knee does much to relief the knee pain from osteoarthritis. There is solid evidence to suggest that it's no better than placebo or sham intervention. A Canadian study in patients with moderate to severe osteoarthritis of the knee found that arthroscopy was no better than physical therapy and a home exercise program. Additionally there is the chance that it may actually cause harm in addition to the risks that go along with a major anesthetic and surgery. Arthroscopies are being sold as a magical procedure that will take care of the pain.

THE RISKS

What they fail to tell you is that the procedure has been linked to increased risk of blood clots, pulmonary emboli (blood clots which travel to the lungs and block their blood supply), and death. Additionally having arthroscopy may increase the odds you'll need a joint replacement sooner than you otherwise would have. And given each procedure costs about $4,000 to $6,000, there's also an argument that precious health dollars are being spent on a treatment that's not supported by evidence. There are surgeons that perform in one single day 8 to 10 or more arthroscopies. There is for sure a financial incentive for the surgeon but additionally there is pressure from the patients because at times they comes to the surgeon saying that a friend or a general practitioner told them to go and have the “clean up”. Those patients need to ask them themselves; what does their friend know and also what does the general practitioner really know about arthroscopies? Basically they know very little. However, in my view it's the specialist's job to educate patients on what appropriate treatments may be. Once it is explained to patients that they don't need that cleanup, "most of them are happy with that". Unfortunately some surgeons may be reluctant to take the time for such an explanation.

THE FATCS

 As reported by Dr. Christopher Centeno back in 2011, a study released back then revealed that the knee arthroscopy rate in US is more than double the rates of knee surgery in Europe or Canada. In addition, despite often long knee surgery recovery times, the number of knee arthroscopic surgeries increased by about 1/2 in the decade from 1996 to 2006. An estimated 5 billion dollars per year is the reported cost of these surgeries alone. We do need to ask ourselves; are we getting what we are paying for?