Surgery isn’t always the answer to sore knees

Nearly half of Canadians aged 65 and over experience osteoarthritis in their knees.

Osteoarthritis is the most common form of arthritis and occurs when the protective cartilage on the ends of bones wears down over time, leading to pain, stiffness and decreased mobility. It frequently occurs in the hips and knees and can be quite painful.

To help improve mobility and treat joint pain, it has been common for older adults with osteoarthritis of the knee to be referred to an orthopedic surgeon, like us, for a knee arthroscopy.

As orthopedic surgeons, we want to ensure that our procedures provide high-value care to patients and do more good than harm. Unfortunately, this is often not the case for knee arthroscopy in older adults with arthritis.

Arthroscopy of the knee for arthritis involves making several small cuts to insert a small camera and instruments to view the joint and trim loose cartilage and wash the joint out.

Now, there is a growing body of research showing that this procedure may not be necessary for most older adults since it usually has the same long-term outcomes as non-operative and less invasive treatment.

Alternative treatments can include weight loss, physiotherapy, exercise, over-the-counter pain medicines such as Tylenol, anti-inflammatories and pain-relieving joint injections.

Knee arthroscopy, on the other hand, is a surgical procedure that typically requires spinal or general anesthetic; there’s always a risk of infections or structural damage to the joint.

Does this mean that all arthroscopy shouldn’t be performed?

No. Rather, arthroscopy needs to be done for the right conditions and on the right patients. For example, meniscus repair surgery for a younger person with a knee injury can help improve function, treat pain and increase mobility.

Unnecessary surgeries mean that our time as surgeons, as well as health-care system resources such as operating rooms and staff, are tied up doing surgeries that don’t add much value to Canadian patients.

These resources could be directed toward other orthopedic procedures that provide pain relief and improved function yet have long waiting lists.

For older patients with osteoarthritis in the knee, arthroscopy is often the wrong choice.

Recently, the Canadian Orthopaedic Association, the Canadian Arthroplasty Society and the Arthroscopy Association of Canada joined to release a set of recommendations on best practices.

The first recommendation is against arthroscopy for initial treatment and management of osteoarthritis in the knee.

It’s well established that physicians tend to overestimate the benefits of our procedures and often underestimate harms.

Recent research shows that the same misconceptions about harms and benefits of common procedures are held by patients themselves.

A culture shift is needed for surgeons, patients and the public on treatment expectations for knee osteoarthritis. Saying no to arthroscopic surgery, and instead undertaking non-operative management, is a challenge for clinicians and patients alike.

Dr. Eric Bohm is a professor at the University of Manitoba and an orthopedic surgeon with the Concordia Joint Replacement Group in Winnipeg. Dr. Ivan Wong is an associate professor at Dalhousie University and an orthopedic surgeon at the QEII Health Sciences Centre in Halifax.

Just Posted

Red Deer to get new plan to end homelessness as problem persists

Despite some successes there’s ‘a long way to go,’ says manager

‘A stronger Alberta:’ Ottawa announces $1.6B for Canada’s oil and gas sector

Ottawa is spending $1.6 billion to help struggling energy companies stay afloat,… Continue reading

Canada ranks 16th on World Economic Forum’s annual gender gap list

TORONTO — Canada has landed the 16th spot in the World Economic… Continue reading

Steel, aluminum tariffs impacting one-third of Canadian exporters: poll

OTTAWA — More than one-third of Canadian exporters say they have been… Continue reading

Canada has fifth biggest AI workforce, but still lacks diversity: study

TORONTO — Canada has the globe’s fifth largest artificial intelligence workforce, but… Continue reading

Chabot scores overtime winner to lift Senators over Predators 4-3

OTTAWA — Thomas Chabot saw an opening and he took it. And… Continue reading

Canadian Marielle Thompson earns World Cup ski cross bronze in season opener

AROSA, Switzerland — Canada’s Marielle Thompson captured bronze at the opening World… Continue reading

Canada doesn’t make Oscars short list for best foreign language film

LOS ANGELES — Canada is no longer in the running for best… Continue reading

Warrant issued for arrest of ‘Schwimmer lookalike’ suspect

LONDON — A British judge has issued an arrest warrant for an… Continue reading

Moneywise: Canadian workers unhappy with pay, want pension plans

Many working Canadians are feeling underpaid and are so worried about their… Continue reading

Brazil police say faith healer has turned himself in

RIO DE JANEIRO — A celebrity faith healer accused of sexually abusing… Continue reading

B.C. hockey coach creates ‘gear library’ to remove cost barrier of sport

VANCOUVER — Nicola Froese says she has always loved playing sports, but… Continue reading

Canada’s Kim McRae finishes seventh at luge World Cup in Lake Placid, N.Y.

LAKE PLACID, N.Y. — Canada’s Kim McRae finished in seventh place at… Continue reading

Most Read