In an interesting research project published in the July 11, 2002 issue
of the New England Journal of Medicine (NEJM)comes a study of the
effectiveness of knee surgery on the elderly. What may be most interesting
about this study is that some patients in the study got "sham surgery"
instead of the real thing. Presently, the popular knee surgery is performed
on about 300,000 mostly elderly patients per year. Arthroscopic knee
surgery for osteoarthritis costs roughly $5,000, per operation or a total of
$1.5 billion a year in the United States.
The NEJM study states that many patients report symptomatic relief after
undergoing arthroscopy of the knee for osteoarthritis. However, researchers
are not sure why patients report such relief. To investigate this
researchers and surgeons at the Houston VA Medical Center divided 180
potential knee surgery patients into three groups. One group got
arthroscopic débridement, one group received arthroscopic lavage, while the
third group got placebo surgery. Patients in the placebo group received
skin incisions and underwent a simulated procedure without actual insertion
of the arthroscope. The patients in the study did not know which group they
were being divided into and therefore did not know if they were receiving
the real or fake surgery.
All the patients who participated in the study were evaluated for two
years after the procedure. During this time these patients still did not
know which group they were in or if they received the sham surgery. The
results showed that during the two year follow up, all three groups said
they had slightly less pain and better knee movement. However, the
sham-surgery group often reported the best results. Researchers attribute
this to the well-known "placebo effect," in which patients feel better
simply because they believe they have been treated.
These findings could prompt insurance companies to refuse to pay for the
procedure. In the Associated Press story on this study Dr. William W.
Tipton Jr., executive vice president of the American Academy of Orthopedic
Surgeons, suggested that other researchers should conduct a similiar study
and duplicate the results before doctors, patients and insurance companies
react. But he did confirm that the study confirms some doctors' growing
suspicions about these procedures.
Dr. Todd P. Stitik, associate professor of rehabilitation at University
of Medicine and Dentistry of New Jersey in Newark, said patients he has sent
for arthroscopic surgery were not helped much. "I don't think this is now
necessarily a reasonable option," he said.