SaveYourself.ca • Sensible advice for aches, pains & injuries
published 9/11/08, updated 6/09/11
It’s a pleasure to report, for once, scientific news that is crystal clear and unambiguous: surgery for osteoarthritis of the knee joint is really, really pointless. We’re talking about “debridement” — basically filing down rough knee cartilage. It sounds like a good idea, in a way. I know I want my knee cartilage to be smooth. Unfortunately, it doesn’t work, and any surgeon still recommending this procedure is out of touch.
For my readers, knowing about this is a valuable perspective on joint problems of all kinds — it really drives home one of the main themes of this website, which is that either:
In 2002, Moseley et al published the results of a fascinating experiment that showed that people who received a fake arthroscopic knee surgery for osteoarthritis had results just as good as people who received the real surgery. It’s unusual, by the way, for surgeons to compare real surgeries to fake surgeries, and that in itself was interesting. But the humungous placebo effect was the really sensational thing.
Since then, other researchers have generally been finding more and more bad news about athroscopic surgery for knee pain, culiminating earlier this year with what was arguably a scientific death blow for the procedure: The Cochrane Collaboration concluded that “there is ‘gold’ level evidence that arthoscopic debridement has no benefit.”
Now New England Journal of Medicine has added more experimental evidence to the pile, reporting that “surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.”
In science, replication of experimental results is the most important way that our confidence in a conclusion increases. The more surprising and counter-intuitive experimental results seem to be, the more important it is to do it again. And again. And again. Every time you get the same results, or similar results, from different scientists, using different methods, the more confident you can be that those results have something to do with “the truth.”
So please do not debride your knees! In fact, be cautious and skeptical about all surgeries that allege to fix mechanical problems with joints — although some of them undoubtedly work, they are all on probation.
Most of the knee pain information on this website is about patellofemoral syndrome and iliotibial band syndrome, the two most common runner’s knee conditions, typically causing pain on the front and side of the knee respectively (learn more about the difference). Arthritis is not my usual subject matter, although I do keep tabs on it (particularly because of the way it is routinely confused with arthritis). For more information about these conditions, see either of my advanced tutorials:
SaveYourself.ca offers an extremely detailed and readable tutorial for this stubborn condition — with the science baked right in. Find out exactly why conventional therapy fails so often. The subject is completely explored in 78 sections, including 25 practical treatment tips. Customers will also receive the popular Trigger Point tutorial for free, a $20 value! Add it to your shopping cart now ($19.95) or read the first few sections for free!
Tried everything? Do not give up yet — there is still hope! SaveYourself.ca offers the most detailed patellar pain tutorial available anywhere. In over 90 highly readable sections, it offers options and insights that many patients and professionals have never considered, supported by more than 130 footnotes. Inspired by the work of surgeon Scott Dye, and firmly grounded in readable analysis of all the science. Add it to your shopping cart now ($19.95) or read the first few sections for free!
