Unproven knee operations still performed

(Medical Xpress)—Despite evidence that arthroscopic surgery is ineffective in treating osteoarthritis of the knee, the procedure is still routinely being performed in Victoria, according to a new study.

A Monash University-led survey published today in the Medical Journal of Australia, found that although overall rates of arthroscopy had declined, this was not the case for osteoarthritis (OA) patients.

Arthroscopy involves the insertion of a camera into the joint for examination and possible treatment of the knee. It is minimally invasive, and can result in faster healing times, but has risks of complications including infection and damage to the knee joint. 

The researchers examined public and private hospital admissions data between 1 July 2000 and 30 June 2009. Nearly 160,000 patients underwent elective knee arthroscopies in this period. Although overall rates of arthroscopy declined, rates for patients with OA of the knee remained steady overall, and actually increased for some age groups.

Monash University's Dr Megan Bohensky of the Centre of Research Excellence in Patient Safety, said a number of studies over the past decade had found arthroscopy no more effective than non-surgical treatments for OA.

"A study of 180 patients in 2002 found, over a two-year follow-up period, no difference in pain and function between OA of the knee patients who had undergone arthroscopy and those who had placebo surgery," Dr Bohensky said. 

"Later studies have backed up these findings, suggesting that there is a need to question the still wide-spread use of arthroscopy of a treatment for OA of the knee. 

"Further work is required to understand why the research evidence is not being effectively translated into clinical practice."

An accompanying editorial by Professor Rachelle Buchbinder of the Monash Department of Epidemiology and Preventive Medicine and Professor Ian Harris of the University of New South Wales was also published the Medical Journal of Australia.

The authors commented on the challenge of changing wide-spread clinical practice, even in the face of credible evidence.