published 9/11/08
Knee Surgery Sure is Useless!
The New England Journal of Medicine “piles on” with still more evidence that arthroscopic knee surgery for osteoarthritis is about as helpful as a Nerf hammer
by Paul Ingraham, Vancouver, Canada MORE
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
Today is knee day at SaveYourself.ca, and for once it’s a pleasure to report 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, which sounds like a good idea (I know I want my knee cartilage to be smooth). Unfortunately, it doesn’t work, and any surgeon still recommending this procedure is hopelessly 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:
- mechanical problems with joints aren’t as much of a problem as you probably thought
- and/or trying to fix them surgically is often useless and risky
A little knee surgery history
In 2002, Moseley published the results of a fascinating experiment that showed that people who received a fake arthroscopic knee surgery had results just as good as people who received the real surgery for osteoarthritis. It’s unusual, by the way, for surgeons to compare real surgeries to fake surgeries. That in itself was interesting. But the humungous placebo effect was the really sensational thing.
People who received a fake arthroscopic knee surgery had results just as good as people who received the real surgery.
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.”
The New England Journal of Medicine piles on
Not wanting to be left out of the party, 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, duplication 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.”
“There is ‘gold’ level evidence that arthoscopic debridement has no benefit.”
So the morale of the story is: 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!
More information about knee pain
For more information about knee pain on SaveYourself.ca, see either of these advanced tutorials, about iliotibial band syndrome and patellofemoral pain syndrome:
Need more IT band pain options?
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Knee pain won’t go?
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