Knee key hole surgery: It can increase your risk of arthritis! Do you really need it?

Knee arthroscopies (key hole surgery) are not new.

They have been common place for a number of years. They are used for debridement (knee wash out), ligament repairs and meniscal tears (the cushiony bit of your knee).

People normally undergo such procedures due to pain or biomechanical abnormalities. For example; affecting one's ability to walk or partake in their chosen past-time. What has become more and more prominent is the increased risk of osteoarthritis over time following having an arthroscopy.

The image here highlights the meniscus and an arthroscopic procedure being conducted. In a recent study by Rongen et al (2017), they set out to examine the long term effects from having such a procedure. They monitored their participants over almost 10 years following an arthroscopic procedure. Their study identified that their is an increased risk of needing a knee replacement later in life following arthroscopy.

Their study identified that arthritic changes are increased following partial removal of the meniscus. The image here demonstrates this. By interfering inside the knee joint, encourages cartilage loss and the increase of bone spurs. Meaning the suffer, later in life suffers even more with arthritic pain. This supports increasing evidence that routine arthroscopic procedures is NOT supported and non-surgical procedures should be the first line of treatment. Yet this practice is still highly prevalent!

Knee arthritis under the view of an x-ray. Arthritis can only be diagnosed by an x-ray. it looks for reduced joints space and roughened edges and whiter, denser bone.

I'd like to re-introduce an image I have used before and one that I have available in my clinic to demonstrate to clients. This image highlights what pathologies and MRI can identify with or without the presence of pain. It is not uncommon to have something wrong with you and have no pain! Pay particular attention to the meniscal row. It is now know that more people have a menisci tear and have no pain than those who don't! Asymptomatic (without pain) menisci tears are extremely prevalent! Rongen et al (2017) also highlight that people usually undergo arthroscopies due to having a bio mechanical deficiency. A commonly asked question by physiotherapists is do you get true locking of the knee? It is now better understood that this question is not a very good indicator for problematic meniscal tear. However... This study's participants were known to have osteo-arthritis. There appears to be no comparison between having no arthritis and known arthritis. The study's measure was how many participants have had to have had a knee replacement. Having a knee replacement does not identify how many people are suffering with arthritis. Many people life with and attempt to manage their daily lives with arthritis without having their knee replaced. In consideration...

Those who underwent arthroscopies now know their surgeon and may be more inclined to trust them and allow the knee to be replaced?... But. The correlation is definitely present. Having arthroscopic procedures does increase your risk of arthritis later in life. As a physiotherapist, I would always try to encourage my clients to manage their pain with exercise and lifestyle changes. However, the only person living with the pain and debilitating daily life is the sufferer. Ultimately the choice is theirs, Our job as professionals is to give the sufferer all of the choices and risks. Not just short term risks, but the potential long term risks too. Can you live with the pain now or take the risk of having painful arthritis later in life?