Should I Have Surgery for Knee Osteoarthritis?

It’s a big question for people living with knee pain. Is surgery worth the risk and expense? While the answer can vary depending on the type and extent of the damage to your knees, the answer in many cases — and unfortunately, in many cases where patients do undergo surgery — is no.

That’s the conclusion drawn by a number of recent studies, including this survey review from the BMJ: Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. The bottom line is that there seems to be no difference (outside the short-term first three months) between pain and functionality for those who undergo arthroscopic surgery and those who rely on more conservative methods such as physical therapy.

“We make a strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease, based on linked systematic reviews; further research is unlikely to alter this recommendation,” the study concludes.

The term “degenerative knee disease,” according to the study authors, is generally synonymous with osteoarthritis, and explicitly includes patients ages 35 and up with knee pain. It does not include those with recent onset of symptoms after major knee trauma or acute onset of joint symptoms.

“Arthroscopic surgery has a role, but not for arthritis and meniscal tears,” Dr. Reed A.C. Siemieniuk, a methodologist at McMaster University in Hamilton, Ontario, and chairman of the panel, told the New York Times recently. “It became popular before there were studies to show that it works, and we now have high-quality evidence showing that it doesn’t work.”

So what are the alternatives?

Steroid injections are sometimes recommended, but if used repeatedly can actually increase the development of arthritis in the joint.

Hyaluronic acid injections are another option that have been effective for some people in delaying the need for knee replacement surgery.

For a more holistic approach, one of the best things you can do is lose weight if you are overweight. Taking the extra pressure of those added pounds off your knees can work wonders.

And finally, you cannot understate the value of working with a licensed physical therapist who specializes in knee pain. From lifestyle tips to exercises to strengthen and relieve pain, a good physical therapist can be just as effective as arthroscopic surgery, but without the risk.