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Arthroscopic knee surgery no better than sham surgery

Discussion in 'Orthopedics' started by Hala, Feb 11, 2014.

  1. Hala

    Hala Golden Member Verified Doctor

    Oct 17, 2013
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    Arthroscopic knee surgery is one of the most common unnecessary surgeries performed today—along with back and hip surgeries, pacemakers, cardiac angioplasties, hysterectomies, and Cesarean sections.

    Several studies over the past decade have highlighted questions about arthroscopic knee surgery, and now, you can add one more to the pile. The meniscus inside your knee is a thin crescent-shaped disc of cartilage that serves as a cushion between your femur and tibia and helps stabilize your knees.

    Over time, your meniscus can develop tears, especially if you have arthritis. The standard orthopedic surgeon's intervention for meniscal tears is performing an arthroscopic partial meniscectomy—trimming the torn meniscus and smoothing the jagged edges of what remains, which assumes the tear is what's causing your pain. However, that may be a faulty assumption.

    Knee Surgery No Better Than Sham

    This latest study, conducted in Finland, examined 146 patients with degenerative meniscal tears (caused by "wear and tear," not acute injury). Researchers divided patients into two groups.

    One group received the standard surgery, and the other received a "sham surgery"—in other words, a fake or placebo intervention where no actual surgery takes place. The study excluded people with knee arthritis, because they tend not to benefit as much from meniscus surgery and the researchers wanted to ascertain if the surgery helps under "ideal circumstances."

    The sham surgery involved the physician's making an incision and poking around without any actual cartilage shaving or cutting. Many of the patients were given epidural anesthesia, so they were awake, making it necessary for surgical staff to use their "theatrical talents" to pull off a believable sham surgery.

    The outcome? One year later, both groups reported equally favorable responses to the procedure—primarily, reduction in knee pain. In the end, the researchers concluded that the real knee surgeries offered no better outcomes than the sham surgeries.

    Arthroscopic surgery on the meniscus is the most common orthopedic procedure in the US, and according to this study, is performed about 700,000 times a year to the tune of $4 billion. Any surgeon who tells you this is the best or only option for your osteoarthritic knee pain will not have a leg to stand on when you show him or her all of the evidence to the contrary.

    Arthroscopic Surgeries Have an Embarrassing Track Record

    Prior to the Finnish study, there were already three prior studies of note that should have orthopedic surgeons rethinking how they treat their knee patients:

    A landmark study in Texas set the ball rolling back, over ten years ago, in 2002. The study involved 180 participants randomly assigned to either have the real operation or sham surgery, in which surgeons simply made cuts in their knees. The real surgery turned out to have no benefits over the sham procedure. This was a classic multi-center (including Harvard) double blind controlled trial that clearly showed the surgery was a $3 billion waste.

    In 2008, a Canadian study compared the benefits of physical and medical therapy to arthroscopic surgery for osteoarthritis of the knee. Researchers concluded that physical and medical therapy provided equal benefit to surgery.

    In 2013, researchers compared the functional outcomes of physical therapy versus arthroscopy for patients with meniscal tears. They found that arthroscopy followed by postoperative physical therapy had no benefit over physical therapy alone.

    See the pattern emerging here? It's hard to miss! Eighty percent of meniscal tears develop from wear and tear over time. If you have pain in your knees from ordinary activities or arthritis, you may be better off skipping the surgery and going straight to physical therapy.

    Of course, there are other non-invasive therapies that can be helpful as well. But it's becoming quite clear that a torn meniscus—at least, the wear-and-tear variety—is not going to be helped by a "surgical trim." Surgeries come with all sorts of risks, and there is no point in exposing yourself to these without some clear advantage.

    If you have a torn meniscus from an accident or injury, the scenario may be different, but I would still recommend you getting a second or even third opinion before going under the knife.

    The Power of Placebo

    With TWO studies now highlighting the benefits of placebo knee surgeries, the power of placebo just can't be ignored. Placebos typically have far fewer side effects (if any) than prescription drugs, injections, or actual surgeries—and they often work just as well as the standard of care.

    Studies have shown that if you think you're receiving a treatment, and you expect that treatment to work, it often does—even if you know you're receiving a placebo.

    This was beautifully demonstrated in the Finnish study—the knee surgery patients knew they might be having a sham surgery, yet they experienced the benefits anyway. But how do placebos work? How can your brain produce healing just because you believe it should be happening?

    Although the exact mechanisms of the placebo effect are not well understood, it seems related to changes in your brain in response to different psychosocial stimuli. Areas of your brain associated with expectations, anxiety, and rewards seem to be involved. Scientific American reported:

    "In recent decades reports have confirmed the efficacy of various sham treatments in nearly all areas of medicine. Placebos have helped alleviate pain, depression, anxiety, Parkinson's disease, inflammatory disorders and even cancer.

    Placebo effects can arise not only from a conscious belief in a drug but also from subconscious associations between recovery and the experience of being treated—from the pinch of a shot to a doctor's white coat.

    Such subliminal conditioning can control bodily processes of which we are unaware, such as immune responses and the release of hormones… Researchers have decoded some of the biology of placebo responses, demonstrating that they stem from active processes in the brain."

    You can tap into your own placebo effect with techniques such as EFT or Emotional Freedom Technique. This is a new way of thinking about healing for most people that can be extremely powerful, especially when combined with a positive outlook and a proactive, disease-preventive lifestyle.


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