Knee Surgery for Middle Aged People – Is It Beneficial? – What Does The Evidence Say?

Back in 2002, a study by the Baylor College of Medicine orthopaedic department in USA said that the operation commonly known as ‘clearing out’ a knee joint in those people who were middle age and who had knee pain from cartilage tears was no better than fake or placebo surgery. We have been passing on this information to our patients who had cartilage tears or whom we suspected had tears (meniscus tears) since then.

We have been advising patients to instead look at the way they walk; their foot mechanics; muscle strength in their hips and legs etc with a view to making their gait as good as possible to avoid overstressing the cartilages of the knees. For example if you have weak buttock muscles, the knees tend to become slightly ‘knock kneed’ and when walking most of the pressure ends up on the inside of the knees thus overloading the medial meniscus ( the cartilage on the inside of the knees ) and potentially causing irritation that is painful.

If you have flat feet the same thing can happen – your knees will tend to be knock kneed on walking which again can overload the inside of your knees. If you have very high arches you can push the stress to the outer aspect of your knees.

We can show you buttock strengthening exercises that encourage you to walk with straighter knees then you will not overload the inside of your knees in the same way. If we can prescribe inner soles for your shoes to correct flat feet or too high arches then that might reduce the irritation too. Both may be better and both are certainly less invasive than surgery that really does not work.

We need also to consider the cause of the pain as one study showed that just as many middle aged people who did not have any knee pain had tears in their cartilage as those with knee pain, so why is the knee painful in some and not in others?

In 2012 the New England Journal of Medicine published a study that showed that patients who only had physical therapy such as chiropractic, physiotherapy or osteopathy for their cartilage tears did just as well as those who had surgery on their knees. It was noticed that people who had tears in this particular study, also had some degree of degeneration in the knees but that this fact did not make any difference to the effectiveness of the surgery. Then research looked at those people whose knees would lock on occasions, which was always thought to be due to a piece of cartilage ‘jamming’ the joint. Again these people did just as well if they were not operated on and just had some kind of physical therapy as those who underwent surgery!

The problem is a lot of orthopaedic surgeons are ignoring this evidence and keep on recommending surgery for these people. In fact in one clinic in the USA, in Cleveland, even more surgeries were being performed after the results of the study came out.

We suggest therefore if you have knee pain, instead of thinking that an operation is the only way you can possibly relieve it – come to see us. Let us assess your walking, running, moving generally and your foot mechanics to see if you have any issues. Let us check your leg and buttock muscle strength and how you do what you do in your activities of daily living. You could find that some treatment and a few ‘tweaks’ of how you do things could make all the difference, without the need to go ‘under the knife’ which probably won’t hel at all anyway!

 

 

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