Why Canada is wasting millions on useless knee surgeries

An international panel of experts is recommending against arthroscopic surgery for almost all patients with degenerative knee diseases such as arthritis.

'Overwhelming evidence' arthroscopic surgery ineffective for arthritic knees, expert panel says

Physiotherapy and weight loss are likely more effective than arthroscopic surgery for knee problems stemming from osteoarthritis. (edwardolive/Shutterstock )

An international expert panel says a common, minimally invasive surgery is largely useless for knee problems stemming from arthritis. Yet most arthroscopic knee surgeries in Canada are performed for this common condition.

The panel of physicians, physiotherapists, academics and patients reviewed 13 randomized trials with control groups and found patients who underwent the procedure had the same outcomes as those who didn't.

Arthroscopic knee surgery involves sending a tiny camera called an arthroscope through an incision in the knee, allowing surgeons to look inside and use small instruments to cut tissue.

It's not helping people in the long run.- Dr Reed Siemieniuk

McMaster University's Dr. Reed Siemieniuk, who chaired the panel, said the ease of the procedure makes it an attractive option for physicians who want to alleviate their patients' chronic knee pain.

"It's minimally invasive. It generally has low risk. But that said, if it's not helping people in the long run, then even small risks can become important when it's so common." 

$31M in health-care spending

Siemieniuk said arthroscopic surgery has been shown to be effective in only a small subset of patients such as those who've had a sports injury or experienced sudden knee trauma from an accident.

Dr. Reed Siemieniuk, of McMaster University, chaired the international expert panel that concluded arthroscopic surgery is ineffective for most chronic knee problems. (University of Toronto)

But the panel's research found that in Ontario alone, of the 27,000 people who had the procedure on their knees in 2013, about 90 per cent were due to arthritis.

With an average cost of $1,300 per procedure, the figures suggests $31 million in health-care spending that likely had no long-term benefit to the patient.

Evidence that arthroscopic surgery is ineffective for arthritis began emerging a decade ago, yet physicians continued to recommend it to their patients to treat secondary problems stemming from the condition such as meniscus tears, sudden pain or clicking and catching of the knee.

No easy answers

In its new clinical guidelines published in The BMJ (formerly British Medical Journal), Siemieniuk and the rest of the panel recommend against arthroscopy for these symptoms.

He said there are no easy answers for chronic knee pain.

"The first few steps are weight loss, physical therapy and painkillers, whether injections or topical creams. But long term, people with arthritis and chronic knee pain eventually go on to needing knee replacement surgery."

Siemieniuk said it is up to health policymakers and physicians to decide how to discourage needless arthroscopic knee surgery as the guidelines are just that.


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