Should You Have Knee Surgery?
Knee surgery is one of the most common orthopedic surgeries in the U.S., but is it effective?
While practicing medicine in primary care, we doctors get to see our fair share of aches, pains, and injuries. The bigger joints are often a common culprit of agony, with the knee joint being one of the worst. After all, we use our legs every day, and we often take them for granted. But those suffering from chronic knee pain will tell you how their quality of life can be truly diminished.
With that being said, it’s no wonder that knee surgery is one of the most popular orthopedic surgeries of all time. And if you are between the ages of 35 and 65 with knee pain, it’s more than likely you have contemplated knee surgery at some point in your life.
Orthopedic knee surgeries have built quite a profitable niche within the medical community. Arthroscopic meniscal tear repairs, the most common knee surgery in the U.S., costs an estimated $4 billion dollars a year alone. This is an operation under anesthesia, making an incision in the knee, inserting a camera to look inside while simultaneously repairing or smoothening out the very common wears and tears on this crescent-shaped piece of cartilage (called a “meniscus”) inside the joint.
Middle-aged patients, who concomitantly suffer from arthritic and age-related changes in the knee causing the wear and tear on the meniscus, comprise the largest group of patients who undergo this operation, and who perhaps should think twice about doing so.
The truth is this: not everyone with knee pain needs knee surgery. In fact, most people don’t.
There was an enlightening study released in the New England Journal of Medicine in 2013 that helped support what doctors, including some orthopedic surgeons, have suspected all along: meniscal tear repairs are just as effective as sham (meaning fake) surgery. They studied 146 patients from age 35 to 65 who were divided blindly (meaning the patients themselves didn’t know which group they belonged to during the entire study) into two groups of patients—one group who did have the true meniscal repair, and another who had an incision (and was led to believe they had the surgery). but no repair was done. Not surprisingly, both groups reported similar improvement after one year.
Yes, this means that this popular knee surgery is no better than a fake operation on the knee for most patients, suggesting that the over 700,000 estimated patients who undergo meniscal repairs each year may be doing so unnecessarily. Pretty astonishing.
Needless to say, surgery should be the last resort.
Why is that? Because knee pain, whether it’s from a meniscal tear, a runner’s knee, or arthritis, typically tends to improve on its own with a conservative measures: anti-inflammatories (such as ibuprofen), activity and exercise modification, physical therapy, and the tincture of time. Needless to say, surgery should be the last resort.
In fact, even an MRI is not a useful tool for most patients with knee pain for these reasons, and can often be a waste of resources that is contributing to the exponentially rising health care costs in this country. Let’s say you find a “tear”—now what? In fact, statistically speaking, you very likely do have a tear by the time you reach middle age. But just because you have a tear doesn’t mean that that is the cause of your pain. And just because you have a tear doesn’t mean you should repair it. And if you are not going to repair it, then an MRI does not provide any useful information.
With all that being said, it doesn’t mean that meniscal repairs should never be considered for anyone. There is a subset of patients who may benefit from this operation—typically, younger athletic patients without significant arthritis and with an acute injury prompting the pain may find the operation worthwhile.
But for the average middle-aged patient, those who are inactive and not losing significant functioning or quality of life, those with moderate to severe arthritis, and/or those with an occasional discomfort that is relatively tolerable, it may be wise to consider other options and discuss them thoroughly with your doctor before pursuing surgery (or even an MRI).
Bottom line: Just because you have a meniscal tear doesn’t mean that it’s the cause of your pain. Additionally, it doesn’t mean that surgery will improve your pain. In fact, for most people, it won’t.
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Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.
Image courtesy of Shutterstock.
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About the Author
Dr. Sanaz Majd is a board-certified Family Medicine physician who graduated from Drexel University College of Medicine in Philadelphia. Her special interests are women’s health and patient education.
