Health Day Reporter
Thursday, December 26, 2013 (HealthDay News)-A new study in Finland suggests that the improvement in knee pain after common orthopedic surgery appears to be primarily due to the placebo effect.
Study published on December 26 New England Journal of MedicineWill have a significant impact on 700,000 patients undergoing arthroscopic surgery each year in the United States to repair a torn meniscus. The meniscus is a C-shaped cartilage pad that protects the knee joint.
In meniscal repair, the orthopedist uses a camera and a small instrument inserted through a small incision around the knee to shave off the damaged tissue. The idea is that pain can be relieved by removing sharp, unstable debris from the joints.
However, increasing evidence suggests that for many patients this procedure does not work as intended.
“Currently, there are several trials, including this one, in which surgeons have examined whether meniscal injury surgery basically achieves something, and the answer through all those studies is no, it’s not.” Said Professor David Felson. Boston University Medicine and Public Health. He was not involved in new research.
For a new study, doctors recruit patients aged 35 to 65 who have had meniscal tears and knee pain for at least 3 months to undergo arthroscopy to examine the knee joint. did. If the patient was not suffering from arthritis and the surgeon looking at the knee determined that they were eligible for the study, he opened the operating room envelope with further instructions.
At that time, 70 patients removed part of the injured meniscus, while the other 76 patients did nothing further. But the surgeon did everything he could to make the fake procedure look real. They sought the same instrument, moving and pushing their knees as they would otherwise, and used a mechanical instrument with the blades removed to simulate the sight and sound of meniscal restoration. They even timed the procedure to make sure one wasn’t shorter than the other. The patient was not informed if he had repaired his knee.
“It’s a well-designed study and it’s amazing,” Felson said.
Both groups improved after surgery. Surprisingly, those who received the fake treatment reported almost the same pain and functional improvement as those who had the actual meniscus repair. The average improvement in both groups ranged from about 20 to 30 points on a 100-point pain scale.
In addition, most patients in both groups were pleased with their results. Studies show that 77% of the surgery group were happy with the results, while 70% did nothing, and 89% of the surgery group had knee pain compared to 83% of the placebo group. Reported an improvement in. Almost everyone said they were willing to repeat this procedure again. Of the 93% of the surgery group, 96% of those who performed the fake procedure.
“We expect a roar from the orthopedic community, which is the most common orthopedic surgery,” said research author Dr. Teppo Jarbinen, a resident of the Department of Orthopedics and Trauma at the University of Helsinki Central Hospital in Finland. Stated.
“I can’t expect people to be happy that someone shows that what they were doing is better than a fake procedure, but what can I do? That’s the proof,” he said. Said.
Surgery for knee pain is superior to physiotherapy for patients with more advanced illnesses, such as those with meniscal injuries who also suffer from osteoarthritis, according to a study published in the same journal in March. I found out.
Despite the latest disappointing results, some experts have stated that it is important not to over-generalize the latest findings.
Dr. Scott Rodeo, an orthopedic surgeon at the New York City Special Surgery Hospital, said:
Rodeo said he believed that meniscal repair could also be useful for patients experiencing mechanical symptoms such as clicking and catching when moving their knees.
And Felson said repairing the meniscus may still be useful for people with sudden knee injuries, such as those who play sports.
But for those who have progressive knee pain and prolongation without relief, Felson said physiotherapy and anti-inflammatory treatment seem to be the best options.
“I think that’s what you’re doing,” he said.
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Source: David Felson, MD, Professor, Medicine and Public Health, Boston University; Teppo Jarvinen, MD, Ph.D. , Resident, Department of Orthopedics and Trauma, University of Helsinki Central Hospital, Helsinki, Finland. Dr. Scott Rodeo, attending an orthopedic surgeon at a New York City Special Surgery Hospital. December 26, 2013, New England Journal of Medicine
Research Questions The Value of General Knee Surgery
Source link Research Questions The Value of General Knee Surgery