British Journal Drops Bomb on Knee Arthroscopy

The British Medical Journal (BMJ) is conducting a campaign called “Too Much Medicine” which suggests that there is an overuse of medical procedures and that it is a threat to health and wastes resources. As part of that campaign, the journal published an editorial criticizing the number of patients who were going in for knee arthroscopy—a keyhole procedure designed to “clean out” the knee joint.

According to Jill Margo, writing for the Financial Review, the BMJ cites a new study that claims the benefits of knee arthroscopy for middle age or older patients are inconsequential and is even potentially harmful. The surgery resulted in a small but significant decrease in pain that lasted only for three to six months.

For the study, Danish and Swedish researchers compared the results of nine randomized trials involving 1, 270 patients between the ages 48 to 63. They found no significant benefit for physical function, Margo reported.

The study found that the rate of deep venous thrombosis (DVT), brought on by the surgery, was more than 4 per 1, 000 cases and the mortality rate almost 1 per 1, 000 cases.

Margo quotes Andrew “Andy” Carr, ChM DSc FRCS FMedSci, a professor at Oxford University’s Institute of Musculoskeletal Sciences, who noted that with rates of surgery at their current level, a substantial number of lives could be saved and cases of DVT prevented each year if this procedure were discontinued or diminished.

Surgeons in the United States perform more than 700, 000 knee arthroscopies per year, according to Margo who writes that the number in the United Kingdom is 150, 000. Almost all are performed on middle-aged and older adults who are experiencing persistent knee pain. An arthroscopy costs about $4, 000 to $5, 000 and Margo writes that there is some evidence suggesting the procedure may accelerate the need for a knee replacement.