Keyhole knee surgery could do more harm than good in middle-aged or older patients

A study conducted by researchers in Sweden and Denmark has found that the negative repercussions of keyhole knee surgery could outweigh the long-term benefits in middle-aged and older patients.

150,000 patients undergo arthroscopic surgery (a minor procedure to treat torn cartilage and arthritic knees) each year in the UK, many of them in their 50s, 60s and 70s. The study, following a review of data collected from 1,270 patients aged between 50 to 63, has revealed that, even though there was a serious risk of harm following the procedure, the benefit gained was ‘inconsequential’, and suggests that exercising could be more effective than undergoing surgery.

Although rare, complications following the surgery include deep vein thrombosis, cardiovascular problems, infections, pulmonary embolism, and loss of life.

The procedure is usually completed in less than an hour and patients are often discharged home the same day. Because the surgery is relatively uncomplicated, it can often be performed on patients who would not have been considered for surgery in the past.

The researchers reviewed the outcome of 18 studies on the benefits and negative consequences of arthroscopic surgery for middle-aged and older patients who had persistent knee pain.

In nine of the studies, there was a small improvement in pain after between three and six months, but the benefits disappeared after that time and no noticeable improvement in physical function was found.

The remaining nine studies looked into the possible harm of the procedure, and showed that the potential side-effects, although rare, were significant.

The most frequently reported problem was deep vein thrombosis, followed by infection and pulmonary embolism, and one in every 1,000 patients died after the operation.

The authors of the study, conducted by the University of Southern Denmark and the University of Lund in Sweden, said “Arthroscopic knee surgery is frequently and increasingly used to treat middle aged and older patients with persistent knee pain.

“Many specialists are convinced of the benefits of the surgical intervention.

“[But] interventions that include arthroscopy are associated with a small benefit and with harms – the small benefit is inconsequential and of short duration.”

They went on to say “The benefit is markedly smaller than that seen from exercise therapy as treatment for knee osteoarthritis.”

Andy Carr, professor of orthopaedic surgery at Oxford University, asked for the procedure to be discontinued for middle-aged and older patients.

Writing in the British Medical Journal, he said “Supporting or justifying a procedure with the potential for serious harm, even if this is rare, is difficult when that procedure offers patients no more benefit than a placebo.

“A substantial number of lives could be saved and deep venous thromboses prevented each year if this treatment were to be discontinued or diminished.”

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Posted by Tony May, Partner/head of Clinical Negligence Department, Chadwick Lawrence LLP (tonymay@chadlaw.co.uk ), Medical negligence lawyers and clinical negligence solicitors in Huddersfield, Leeds, Wakefield and Halifax, West Yorkshire.

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