Knee arthritis: Surgery vs. therapy

Seven's On Call with Dr. Jay Adlersberg
September 10, 2008 3:35:42 PM PDT
There is new information about what works when it comes to treating arthritis. Osteoarthritis is often treated with a surgical procedure to clean out debris in the joint, using a tiny scope inserted directly into the knee. But an article in the New England Journal of Medicine says the surgery works, but no better than other treatments.

Jeff Podesta has been an avid tennis player for years. He's a competitor, and his knees have paid the price. Ten years ago, he had arthroscopic surgery on both for athletic injuries. And this year, there were more symptoms.

"Tremendous pain from arthritis in both knees," he said. "I'm always on the tennis court, and I needed to make sure I could get back on the tennis court."

Jeff had osteoarthritis, which can cause fraying of the cartilage, and some doctors recommend arthroscopic surgery to clean out the joint and smooth the cartilage. But the new study says that for simple arthritis pain, the surgery works no better than pain pills and physical therapy.

Dr. Lisa Mandl is a rheumatologist. She says surgery doesn't stop the patients' arthritic process.

"They weigh the same, they're doing the same activity, they still may be bow-legged or knock-kneed," she said. "And all the forces causing the joints to deteriorate are still there."

The study compared patients over two years.

There are times when arthroscopy may help in an arthritic knee. That's when there's a second problem in the knee causing pain, such as a torn cartilage which can be repaired through the scope.

Torn cartilage is what Jeff had causing his pain, not his arthritis. Dr. Robert Marx was able to operate successfully and repair the cartilage in both knees.

"I've been very fortunate in the last four weeks that the pain has gone away," Jeff said.

Dr. Marx wrote the editorial on the report. He says there is a place in knee arthritis for surgery, but a different type of surgery.

"Once the arthritis becomes very severe, the appropriate operation is a knee replacement, not arthroscopy," he said.

Non-surgical treatment for knee arthritis can include physical therapy, over-the-counter pain killers, injections and even acupuncture. A brace can be used for sports or other intense activity.

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Here are ways to protect your joints from osteoarthritis or slow its progression:

  • Lose weight. Excess weight stresses hips, knees and other joints; every pound lost reduces the load exerted on the knee for each step by 4 pounds.

  • Get active. Exercise strengthens the muscles around joints, which can prevent cartilage from wearing down.

  • Stay straight. Good posture protects the neck, back, hip and knee joints.

  • Don't sit still. Switching positions can decrease joint and muscle stiffness.

  • Lift carefully. Use your biggest and strongest joints and muscles when lifting or carrying to avoid straining smaller joints.

  • Break it up. Rest between periods of heavy activity to prevent repetitive stress on joints that can accelerate wear and tear.

  • Don't overdo it. Get help for any job that's too physically demanding and don't be a "weekend warrior" by jumping into sports your body isn't prepared to handle.

    Source: Arthritis Foundation.

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    For more information, visit Rheumatology.org.

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    STORY BY: Medical reporter Dr. Jay Adlersberg

    WEB PRODUCED BY: Bill King

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