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Alternative to Knee Surgery? 1/4 of Patients End up with a Knee Replacement


By Jessica Kelner, D.O. - February 20, 2019

Contrary to the widespread belief that arthroscopic knee surgery "fixes" the knee, recent research has shown that is not always the case. The research is strongly encouraging us to consider an alternative to knee arthroscopy.  Why? An alarming 1/4 patients that undergo knee arthroscopic surgery will end up with a knee replacement within 3 years! 

Arthroscopic knee surgery began in the 1980s and at that time, seemed to be a great advancement in the surgeries that came before it.  Arthroscopic knee surgery for degenerative knee disease is the most common orthopedic procedure performed in the US and globally.   It is performed more than two million times each year.  This type of procedure when used for degenerative knee disease cost over 3 billion dollars in the US alone.  Why is this procedure still so popular despite the recommendations against it? Some continue to advocate for this type of surgery for meniscal tears, mechanical symptoms, and acute symptoms as well as there is the financial incentives for the health care system.  

Another reason not to rush into surgery:  35% of people greater than 50 years of age have evidence of a meniscal tear on MRI, even though two thirds of these tears are asymptomatic. the meniscus isn't always the problem.  There are many reasons one may have pain in the knee; some may not be revealed on an MRI. 

This report published in the May 2017 Journal BMJ compares the effectiveness of of arthroscopic surgery for treating degenerative knee disease to conservative treatments like physical therapy and medication.  This report revealed that <15% of participants that had  arthroscopic surgery resulted in even a small improvement in pain or function at three months after surgery.  Moreover, this benefit was not sustained at one year. 

This study looked at patients over the age of 50 who had arthroscopic surgery to "repair" a meniscus tear.  Something to note, is at this age, most often meniscus tissue is removed that is degraded.  These patients were then evaluated for the nee for a Total Knee Replacement after failing the arthroscopic surgery. Unfortunately, 26% of them needed a knee replacement within 3 years

Another study, called the MeTeOR trial was trying to assess two different treatment strategies for knee pain: conservative therapy vs arthroscopic surgical repair. The study was composed of 351  participants with knee pain, meniscal tear, or osteoarthritic changes on x-ray. They were randomized into two groups, arthroscopic repair or physical therapy. During a 5 year follow up of the 351 participants of the study, it was determined that both the conservative group and surgery group had similar degrees of improvement, however,  10% of those that had arthroscopic surgery ended up getting a Total Knee Replacement. Given that more than 400,000 Total Knee Replacements are done in the US every year, this study suggests that an excess of 40,000 knee replacements are performed in surgically treated patients.

These studies are only the beginning of the research into the alternatives to orthopedic surgery. As advancements are made through alternative treatments like regenerative medicine, I suspect more studies, like this one , will be done on prolotherapy, Platelet Rich Plasma, and Stem Cell treatments. Hopefully, with more research and more education and incorporation of these types of treatments into the clinical setting, more patients will have this as an available treatment option.  

If you would like to learn more about non-surgical alternatives to knee pain, check out FORM-medical.com.