"Keyhole" arthroscopic surgery should rarely be used to repair arthritic knee joints, a panel of international experts says in new clinical guidelines.
Clinical trials have shown that keyhole surgery doesn't help people suffering from arthritis of the knees any more than mild painkillers, physical therapy or weight loss, said lead author Dr. Reed Siemieniuk. He is a health researcher with McMaster University in Toronto, Canada.
"You can make a pretty strong statement saying that from a long-term perspective, it really doesn't help at all," Siemieniuk said. "If they knew all the evidence, almost nobody would choose to have this surgery."
Play Video
More than 300,000 Americans get hip replacement surgery each year. A growing number of patients can be in and out of the hospital faster than eve...
Keyhole surgery is one of the most common surgical procedures in the world, with more than 2 million performed each year, Siemieniuk said. The United States alone spends about $3 billion a year on the procedure.
The new guidelines -- published online May 10 in theBMJ-- were issued as part of the journal's initiative to provide up-to-date recommendations based on the latest evidence. The guidelines make a strong recommendation against arthroscopy for nearly all cases of degenerative knee disease.
This includes osteoarthritis as well as tears of the meniscus, the padding between the two leg bones in the knee, Siemieniuk said.
"With age and with use, the grinding of the two bones together can break down that padding," he said. "It's very common to see little rips and tears in that padding in patients with arthritis."
Siemieniuk and his colleagues noted that a trial published in 2016 showed that surgery was no better than exercise therapy in patients with a meniscus tear.
Despite this and other medical evidence, most guidelines still recommend keyhole surgery for people with meniscus tears, sudden onset of symptoms like pain or swelling, or mild to moderate difficulties with knee movement.
Arthroscopic surgery relies on small incisions through which a tiny camera and miniature instruments are inserted. Doctors can remove or repair damaged tissue without having to cut the knee open.
The American Academy of Orthopaedic Surgeons currently advises against performing arthroscopic surgery in patients with full-fledged knee osteoarthritis, said Dr. Kevin Shea, an academy spokesman.
"Most orthopedic surgeons have dramatically reduced arthroscopic surgery in patients with degenerative arthritis," Shea said. "Most I know have abandoned it over the last 10 to 15 years."
However, arthroscopic surgery still can help people with joint movement problems caused by meniscus tears who have not developed moderate or severe knee osteoarthritis, said Shea.
Those patients should be treated first with mild painkillers and exercise therapy, but keyhole surgery should remain an option for them, he added. Shea is an orthopedic surgeon based in Boise, Idaho.
"Not that long ago, I operated on a 67-year-old retired schoolteacher who's an avid skier," Shea said. "She had no arthritis in her knee but a huge meniscus tear that kept locking, catching and popping. Not offering treatment to her would not have been fair."
Under theBMJguidelines, patients with meniscus tears should be treated with painkillers and physical therapy, as well as weight loss if they are overweight, Siemieniuk said. Knee replacement surgery is the last treatment option, done once degeneration has progressed to the point where all other therapies don't work.
There is a financial incentive for doctors and hospitals to perform unnecessary keyhole surgeries, but Siemieniuk said these surgeries also might be prompted by the desire to treat a painful medical condition.
"It's hard to take away one of the options from people when chronic knee pain and arthritis can be very debilitating," he said. "And there's an expectation from patients that by the time they see a surgeon, the surgeon is going to have something to be able to offer them."
Inertia might also play a role. "It's a lot easier to introduce a new treatment into clinical care than to de-implement one that we later find out doesn't work," Siemieniuk said. "That's what we're seeing here."
Keyhole surgery has its downsides. Recovery can last anywhere from 3 days to 6 weeks, Siemieniuk said, and there is a risk of blood clots or infection in the knee.
Patients should go through a shared decision-making process with their surgeon, questioning whether this surgery would truly help them, he said.
The surgery still can be useful to fix torn ligaments or repair damage caused by severe trauma, Siemieniuk said. But in most cases, he said, given the evidence, insurers "may choose not to fund it, which I think would be appropriate."
Follow this link:
"Keyhole" surgery not helpful for knee arthritis, experts say - CBS News
- Pharmacist explains best diet to reduce arthritis, inflammation and joint pain - The Mirror - March 10th, 2024
- Teen Raises Funds to Fight Arthritis - Arthritis Foundation - March 10th, 2024
- Is there a higher risk of depression among specific populations of patients with rheumatoid arthritis? - News-Medical.Net - March 10th, 2024
- Here's How to Explain Your Arthritis Pain to Your Doctor So They Actually Get It - Northwest Georgia News - March 10th, 2024
- Despite Their Prevalence, Arthritis, Neck and Back Pain Receive Few Research Dollars, Analysis Finds | BIDMC of ... - Beth Israel Deaconess Medical... - March 10th, 2024
- This Is the Difference Between Rheumatoid and Psoriatic Arthritis - Prescott Daily Courier - March 10th, 2024
- The #1 Early Sign of Arthritis Most People Miss, According to a Rheumatologist - Northwest Georgia News - March 10th, 2024
- The Efficacy and Safety of Apremilast in the Management of Psoriatic Arthritis: A Systematic Review and Meta-Analysis - Cureus - March 10th, 2024
- MU Researchers Participating in International Clinical Study Targeting Prevention of Osteoarthritis - University of Missouri School of Medicine - March 10th, 2024
- Review: Real-World Evidence Confirms Effectiveness and Safety of Adalimumab Biosimilar SB5 - The Center for Biosimilars - March 10th, 2024
- A Gender-Bias-Mitigated, Data-Driven Precision Medicine System to Assist in the Selection of Biological Treatments of ... - Cureus - March 10th, 2024
- Young arthritis cases are on the rise, new research suggests - The Examiner - March 10th, 2024
- Quiz: ACR Guideline for the Treatment of Psoriatic Arthritis - MD Magazine - February 10th, 2024
- Psoriatic arthritis: What to know about medications for children - Medical News Today - February 10th, 2024
- Ancient Egyptian woman had holes on her bones. Experts say its rare case of disease - Miami Herald - February 10th, 2024
- Arthritis and Pregnancy: Fertility, Gestation, Postpartum - Verywell Health - February 10th, 2024
- 3500-year-old burial of Nubian woman reveals 1 of world's earliest known cases of rheumatoid arthritis - Livescience.com - February 10th, 2024
- Impact of frailty severity and severe pain on cognitive function for community-dwelling older adults with arthritis: a cross ... - Nature.com - February 10th, 2024
- IHL-675A: Advancing Towards Innovative Arthritis Solutions, with Mark Bleackley, PhD - MD Magazine - February 10th, 2024
- Insomnia, Shorter Sleep Duration Linked to the Risk of Autoimmune Arthritis - MD Magazine - February 10th, 2024
- Advancements in Psoriatic Arthritis Treatment for Children: A Beacon of Hope - Medriva - February 10th, 2024
- Breakthrough Molecule RvT4 Reverses Inflammation and Clears Arterial Blockages in Rheumatoid Arthritis Patients - SciTechDaily - February 10th, 2024
- Personal Experience with Psoriatic Arthritis and Atopic Dermatitis - Medriva - February 10th, 2024
- EULAR Recommendations on Imaging in Crystal-Induced Arthropathies (CiA) - Medriva - February 10th, 2024
- The Importance of Ultrasound-Guided Synovial Biopsy in the Workup of Seronegative Inflammatory Arthritis: A Case ... - Cureus - February 10th, 2024
- Autoimmune diseases like lupus, MS, and rheumatoid arthritis strike far more women than men. Scientists now think they know why - Fortune - February 2nd, 2024
- Multiple Ulcers in the Ileum and Lymphadenopathy Following the Usage of Methotrexate in a Patient With Rheumatoid ... - Cureus - February 2nd, 2024
- These are the best arthritis creams of 2024, according to health experts - Yahoo Life - February 2nd, 2024
- Do Your Joints Ache When a Storm Is Brewing? Here's What's Really Happening - DISCOVER Magazine - February 2nd, 2024
- Olympic bronze medalist opens up about balancing arthritis with motherhood and triathlon - TRI247 - February 2nd, 2024
- Some Dinosaurs May Have Had Arthritis 90 Million Years Ago - IFLScience - February 2nd, 2024
- 3500-year-old remains of ancient Egyptian suffering from rheumatoid arthritis uncovered - Xinhua - February 2nd, 2024
- Lupus and other autoimmune diseases strike far more women than men. Now there's a clue why - The Associated Press - February 2nd, 2024
- Rheumatoid Arthritis Awareness Day on February 2: What you need to know - CNBCTV18 - February 2nd, 2024
- Rheumatoid Arthritis Awareness Day 2024: Signs, Symptoms, Diagnosis, and Prevention - News18 - February 2nd, 2024
- Improving arthritis in cold weather | Health Smart - WPMT FOX 43 - February 2nd, 2024
- Rheumatoid Arthritis Awareness Day: History, Significance And All You Need To Know - ABP Live - February 2nd, 2024
- Dietary Factors Tied to Osteoarthritis Pain | MedPage Today - Medpage Today - February 2nd, 2024
- Cold-weather coping tips for people with arthritis, osteoporosis and lung diseases - Southernminn.com - February 2nd, 2024
- How to manage arthritis and joint pain: Effective tips for knee pain relief - Health shots - February 2nd, 2024
- New study illuminates the genetics of thumb arthritis treatment - News-Medical.Net - January 25th, 2024
- Rheumatoid arthritis: 30 minutes of walking may lower blood pressure - Medical News Today - January 25th, 2024
- RA Disease Activity Assessed Too Little After Starting TNFi - Medscape - January 25th, 2024
- Lifestyle tips for youth's bone health: Avoid these habits to prevent arthritis - Hindustan Times - January 25th, 2024
- Best arthritis pain relief cream of 2024, according to experts - AOL - January 25th, 2024
- Vasculitis, an Early Unusual Presentation of Rheumatoid Arthritis: A Case Report - Cureus - January 25th, 2024
- Patients with later menarche, earlier menopause have higher risk for rheumatoid arthritis - Healio - January 25th, 2024
- Investigating Maternal Inflammatory Arthritis and Pregnancy Outcomes < Yale School of Medicine - Yale School of Medicine - January 25th, 2024
- Rheumatoid Arthritis and Diabetes: What's the Connection? - Health Central - January 25th, 2024
- Oxidative DNA Damage and Zinc Status in Patients With Rheumatoid Arthritis in Duhok, Iraq - Cureus - January 25th, 2024
- Changes Afoot for the Treatment of Psoriatic Arthritis with Marked Gains in Preference and Utilization of IL-17 Inhibitors - Yahoo Finance - January 25th, 2024
- The Connection Between Potassium and Rheumatoid Arthritis - Health Central - January 25th, 2024
- What Is the ACR20 (American College of Rheumatology) Criteria? - Health Central - January 25th, 2024
- RA Treatment Advances and Where They Are Headed - Health Central - January 25th, 2024
- TMC Medical Minutes- Arthritis & Cold Weather - KXII - January 25th, 2024
- How to deal with joint and arthritis pain in the cold weather - Crossroads Today - January 25th, 2024
- Arthritis: Regular exercises, calcium-rich diet and other habits to keep your bones strong and healthy - Moneycontrol - January 25th, 2024
- Men With Arthritis Have Higher Fertility Rates, Study Finds - Zenger.News - January 25th, 2024
- Pain on Top of Foot: 5 Causes, Swelling, Treatment - Verywell Health - January 25th, 2024
- Understanding Rheumatoid Arthritis in Women: Genetics, Hormones, and Impact - Medriva - January 25th, 2024
- Arthritis | Johns Hopkins Medicine - January 9th, 2024
- Ideal cardiovascular health metrics have better identification of arthritis - BMC Public Health - BMC Public Health - January 9th, 2024
- Acupuncture for Arthritis: Benefits and Risks - Verywell Health - January 9th, 2024
- Why do arthritic horses have more trouble during the winter? - EQUUS Magazine - January 9th, 2024
- Rather than roll over and die, I'm like, 'No, I still want to play': Steve Morse says arthritis diagnosis forced him to ... - Guitar.com - January 9th, 2024
- Top Signs that Your RA Treatment May No Longer Be Working - Health Central - January 9th, 2024
- What Is The Life Expectancy Of Rheumatoid Arthritis? A Review By Doctors - MSN - January 9th, 2024
- Nature Coast Orthopaedics | arthritis care | medicare and most insurance accepted | Beverly Hills, FL | chronicleonline ... - Citrus County Chronicle - January 9th, 2024
- Millions of arthritis patients could struggle to get blockbuster drug, as CVS pulls it from pharmacies - Daily Mail - January 9th, 2024
- What Is Arthritis? | Arthritis Foundation - May 17th, 2023
- Procedure to Surgery for Arthritis Is Recommended After First Failed Non-Operative Therapy - DocWire News - March 29th, 2023
- Higher Prevalence of Sarcopenia Reported in Patients with Rheumatoid Arthritis - Rheumatology Network - October 7th, 2022
- Exploring the Relationship Between Psoriatic Arthritis and Psoriasis - Dermatology Times - October 7th, 2022
- Are Tomatoes Bad For Arthritis? Here's What An MD Has To Say - Women's Health - October 7th, 2022
- Tocilizumab for Treating ICI-Induced Arthritis and Colitis - DocWire News - October 7th, 2022
- Why Arthritis Is A Clear And Present Danger, And How We Can Fight It - CNBCTV18 - October 7th, 2022
- Arthritis: Five cruciferous veg 'block inflammatory process' - backed by 10-year study - Express - October 7th, 2022
- 5 Exercise Habits for Arthritis in Your 50s - Eat This, Not That - October 7th, 2022
- Arthritis: 8 types of fish can cause acid crystals to build up in joints - 'very painful' - Express - October 7th, 2022
- EMA Issues Positive Opinion on the Safety of Filgotinib - Medscape - October 7th, 2022