Study Reveals Therapy Often as Effective as Surgery in Treatment of Osteoarthritis of Knees

A Canadian-led study on the usefulness of arthroscopic surgery for the treatment of osteoarthritis of the knees revealed that many people benefit as much from physical therapy and mild pain relievers as they do from arthroscopic surgery.

The study, whose results were published in the September 11, 2008 issue of the New England Journal of Medicine, was conducted over a period of two years, involving 178 men with osteoarthritis. The average age of those in the study was 60.

All 178 study participants received:

• Weekly therapy for three months to strengthen knee muscles

• Instructions on exercises to be done at home twice daily

• Medications such as ibuprofen, acetaminophen, glucosamine or chondroitin supplements, and injections of a knee lubricant, depending on the severity of pain

Ninety-two, or about half of the participants, were randomly chosen to receive arthroscopic surgery in addition to the above treatment. After two years, each group — those who received the non-surgical treatment only and those who received the treatment and the surgery — reported “the same levels of pain, physical function and quality of life” (www.cbc.ca).

What Is Osteoarthritis?

Osteoarthritis is the most common form of the chronic disease arthritis. 1 in every 10 Canadians and 27 million Americans have osteoarthritis. It's a disease that most often begins to present symptoms after the age of 40 and is caused by breakdown of cartilage that sits at the end of bones and act as shock absorbers. Breakdown of this cartilage allows bones to rub together at joints, resulting in stiffness, pain, and limiting range of motion.

What is Arthroscopic Surgery?

Arthroscopic surgery is a minimally invasive surgery that involves a doctor inserting an arthroscope and other instruments into the involved joint—in the case of this study, the knee joint—through small incisions so that fragments of cartilage can be removed and the joint surfaces smoothed.

What Was The Conclusion Reached By Study Physicians?

Based on the responses of both the study participants who received only physical therapy and mild pain relievers and those study participants who received arthroscopic surgery in addition to physical therapy and mild pain relievers, it was determined that arthroscopic surgery in the treatment of osteoarthritis of the knee should be employed in fewer patients.

Arthroscopic surgery should be limited to a minority of patients who have milder symptoms, large tears in the cartilage, or other damage to the meniscus (the cartilage pads between upper and lower legs—the knee pad).

What Is the Importance of the Outcome of this Study?

Any time surgery is involved, there are risks associated with it, including infection, swelling, etc. Dr. Robert Marx of the Orthopedic Surgery Department at the Hospital for Special Surgery in New York has determined that treatment decisions — whether to use therapy and medication alone or to also use arthroscopic surgery — should be determined on a case-by-case basis.

In a related study, magnetic resonance imaging scans (MRI) from 991 randomly selected people, ages 50 to 90, from Framingham, MA. found that nearly 1/3 of those people had a tear or other damage to the knee pad; of those, nearly 2/3 reported no pain or stiffness in the previous month.

The outcomes of these studies should cause physicians to re-think the need for adding arthroscopic surgery to the physical therapy and mild pain medication regimens used in treatment of osteoarthritis of the knee.

Sources:

http://www.cbc.ca/health/story/2008/09/10/knee-surgery.html?ref=rss
http://content.nejm.org/cgi/content/short/359/11/1097

Note from Ben Kim:

In my experience, the three most effective ways to address and prevent osteoarthritis of your weight-bearing joints are:

1. Reach and maintain your ideal body weight - the less weight your ankles, knees, and hips have to carry, the healthier they will be.

2. Avoid activities that repeatedly cause pain and inflammation in your joints. Some people can run 8 miles a day without having their knees joints suffer. Other people experience premature breakdown of cartilage with just 20 minutes of running on a daily basis. The key is to listen to your body, and to enjoy activities that don't result in significant pain/discomfort.

3. Avoid or minimize your intake of animal protein, mainly dairy and flesh meats like chicken, beef, pork, duck, venison, buffalo, etc. Eggs and wild fish tend to be better tolerated than dairy and flesh meats by the vast majority of people.

   It's impossible to state with certainty why avoiding dairy and most flesh meats is good for your joints, but my clinical experiences have led me to believe that most concentrated sources of animal protein can trigger autoimmune-related reactions in the body, and in some people, these reactions may lead to breakdown of cartilage.

   The bottom line is that if you have osteoarthritis in your knees, you have very little to lose by avoiding dairy and most flesh meats for 3 months. This step alone has led to full recoveries in a number of my patients.

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