Keyhole surgery 'not recommended for knee disease'
11th May 2017 – Keyhole surgery to relieve symptoms of degenerative knee disease is an inappropriate treatment for almost all people with this condition, an international panel of experts is advising.
They say new evidence shows that the surgical technique is unlikely to relieve pain or improve movement.
Degenerative knee arthritis, or degenerative knee disease, is a long-term condition in which symptoms fluctuate.
One common form of treatment is known as arthroscopy – a type of keyhole surgery used to diagnose and treat problems with joints.
It involves inserting a thin, metal tube that contains a light source and a camera so that the surgeon can see what's happening inside. It is also possible for tiny surgical instruments to be used alongside an arthroscope to allow the surgeon to carry out treatment.
However, evidence has suggested that arthroscopic knee surgery offers little benefit for most patients and is not cost effective. Results of a trial published in The British Medical Journal (BMJ) in 2016 showed that among patients with meniscus tear (damage to the rubbery discs that cushion the knee joint) surgery was no better than exercise therapy.
Now, a panel of bone surgeons, physiotherapists, clinicians and patients with experience of this type of treatment have analysed the effectiveness of arthroscopy.
They found that arthroscopic knee surgery does not, on average, result in an improvement in long-term pain or function for almost everyone with knee pain.
Also, there are potentially harmful side-effects associated with this type of treatment.
As such, they strongly recommend that arthroscopy is not offered to almost all patients with degenerative knee disease.
It is unlikely that new trials will alter the evidence, they add.
Commenting on the recommendations in an emailed statement, Mark Wilkinson, professor of orthopaedics at the University of Sheffield and spokesperson for Arthritis Research UK, says: "Degenerative arthritis is a group of conditions where the main problem is damage to the cartilage which covers the ends of the bones.
"Painful and debilitating degenerative knee arthritis affects around 4 million people in the UK.
"Previous studies have shown that knee arthroscopy is not recommended for the symptoms of pain and loss of function for people with degenerative knee arthritis. People with mechanical symptoms, such as locked knee, are more likely to benefit for this type of surgery. Current guidelines support this.
"Anyone with pain and loss of function in their knee joints will find benefit from lifestyle modification, exercise, physiotherapy, suitable pain medication, or joint replacement when non-surgical treatment becomes no longer effective."