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Showing posts with label Orthopedic surgery. Show all posts
Showing posts with label Orthopedic surgery. Show all posts

Monday, December 30, 2013

Common Knee Surgery Does Very Little for Some, Study Suggests

A popular surgical procedure worked no better than fake operations in helping people with one type of common knee problem, suggesting that thousands of people may be undergoing unnecessary surgery, a new study in The New England Journal of Medicine reports.

The unusual study involved people with a torn meniscus, crescent-shaped cartilage that helps cushion and stabilize knees. Arthroscopic surgery on the meniscus is the most common orthopedic procedure in the United States, performed, the study said, about 700,000 times a year at an estimated cost of $4 billion.

The study, conducted in Finland, involved a small subset of meniscal tears. But experts, including some orthopedic surgeons, said the study added to other recent research suggesting that meniscal surgery should be aimed at a narrower group of patients; that for many, options like physical therapy may be as good.

The surgery, arthroscopic partial meniscectomy, involves small incisions. They are to accommodate the arthroscope, which allows doctors to see inside, and for tools to trim torn meniscus and to smooth ragged edges of what remains.

The Finnish study does not indicate that surgery never helps; there is consensus that it should be performed in some circumstances, especially for younger patients and for tears from acute sports injuries. But about 80 percent of tears develop from wear and aging, and some researchers believe surgery in those cases should be significantly limited.

“Those who do research have...
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Friday, December 27, 2013

Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear

Today's post was shared by NEJM and comes from www.nejm.org

Background

Arthroscopic partial meniscectomy is one of the most common orthopedic procedures, yet rigorous evidence of its efficacy is lacking.

Methods

We conducted a multicenter, randomized, double-blind, sham-controlled trial in 146 patients 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis. Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery. The primary outcomes were changes in the Lysholm and Western Ontario Meniscal Evaluation Tool (WOMET) scores (each ranging from 0 to 100, with lower scores indicating more severe symptoms) and in knee pain after exercise (rated on a scale from 0 to 10, with 0 denoting no pain) at 12 months after the procedure.

Results

In the intention-to-treat analysis, there were no significant between-group differences in the change from baseline to 12 months in any primary outcome. The mean changes (improvements) in the primary outcome measures were as follows: Lysholm score, 21.7 points in the partial-meniscectomy group as compared with 23.3 points in the sham-surgery group (between-group difference, −1.6 points; 95% confidence interval [CI], −7.2 to 4.0); WOMET score, 24.6 and 27.1 points, respectively (between-group difference, −2.5 points; 95% CI, −9.2 to 4.1); and score for knee pain after exercise, 3.1 and 3.3 points, respectively (between-group difference, −0.1; 95% CI, −0.9 to 0.7). There were no...
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Thursday, December 26, 2013

You may not be better off after knee surgery

Today's post is shared from cnn.com 

(CNN) -- Patients who underwent simulated knee surgery fared just as well as those who got the real deal, according to a new study that's raising eyebrows about the most common orthopedic procedure performed in the United States.

The findings, published Thursday in the New England Journal of Medicine, add to a string of papers suggesting that arthroscopic partial meniscectomy fails to help many patients. The operation typically is performed to relieve knee pain, whether from wear or from an injury.

But other doctors say it's still too soon to draw sweeping conclusions.

The study, which was conducted in Finland, followed 146 patients between the ages of 35 and 65 with symptoms of degenerative wear and tear of the meniscus, a disk-shaped piece of cartilage that acts as a shock absorber between the shinbone and thighbone. They had no detectable arthritis, suggesting that any pain was due to a problem with the meniscus.

About half the patients underwent an arthroscopic meniscectomy, in which a surgeon inserts a blade through a tiny incision in the knee, and essentially shaves down the rough, frayed edges of the meniscus.

The other half underwent an elaborately staged "sham" surgery, in which the doctor made an incision and poked around without any actual manipulation, shaving or cutting.

A year later, there was no significant difference in the knee pain reported by patients in each group. Nearly two-thirds on each side said they were happy with the results, and most said...


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