knee surgery causes knee arthritis

DOES KNEE SURGERY CAUSE KNEE ARTHRITIS?
SEEMS SO

Chronic Knee Pain

The meniscus is needed to distribute the body weight across the knee. Without the meniscus the body weight is distributed unevenly on the femur and tibia possibly leading to early arthritis to the knee joint.  The tear of meniscus is among the most common knee injuries.”    – From Wikipedia’s definition of “Unhappy Triad“.  The Unhappy Triad is essentially a “blown knee”.

“There have been several trials now, including this one, where surgeons have examined whether meniscal tear surgery accomplishes anything, basically, and the answer through all those studies is no, it doesn’t.”   – Dr. David Felson, professor of medicine and public health at Boston University, being quoted for the December 26, 2013 issue of WebMD.  The article itself (Study Questions Value of Common Knee Surgery Procedure to Repair a Torn Meniscus Worked No Better than a Fake One to Ease Lingering Pain) was written by Brenda Goodman

“Knee Arthroscopy for Osteoarthritis:  With this procedure, a surgeon places a tiny camera in the knee, then inserts small instruments through other incisions to repair torn or aging cartilage. Studies show the operation works well when patients have in fact torn their meniscus, but it is no more successful than noninvasive remedies in treating osteoarthritis of the knee.”  – From an article in the August issue of AARP by called Four Surgeries to Avoid by Karen Cheney.  Stick around and I will show you that Cheney’s second sentence is patently false.

“I have said repeatedly that surgery to trim cartilage in the knee is worthless. I have seen many patients who have had cartilage removed by surgeons for an average charge of $5000 and then they must have a knee replacement several years later. The surgeon must know about the harm he is doing because he has to see his patients for followup, when many of them require knee replacement surgery.”  – Dr. Gabe Mirkin (MD) from his May 29, 2013 article Arthroscopic Knee Surgery is Usually Useless

“If the meniscus or menisci are removed then the cartilage is more vulnerable and starts to rub together.  This can create a ‘bone on bone’ situation over time and more arthritis sets into the knee joint. Meniscus tissue in the knee does not grow back so it is NOT advisable to ‘clean it out’ because over time removing  part or all of the meniscus creates more problems in the knee joint.   – Dr Alexandria Schnee from her April 24, 2013 article, Physical Therapy is As Beneficial As Knee Surgery for A Torn Meniscus; Study Finds

A recent article by an impressive array of orthopedic surgeons and sports doctors on Medscape’s Emedicine site (Meniscus Injuries) revealed that, “Conservative treatment should be attempted in all but the most severe cases.”  But why?  After all, surgeries for torn meniscus are exceedingly common (about three quarter million per year), and we all know people — particularly if you are an athlete — who have had this surgery.  Unfortunately, the more we learn about surgical repairs of torn meniscus, the more scared we should be of this surgery.

A recent study was presented at the annual meeting of Radiological Society of North America called Meniscal Surgery Markedly Increases Risk for Incident Osteoarthritis and Cartilage Loss in the Following Year.  The very name of this study begs the question of just how markedly is “markedly”?  It seems that physicians looked at a group of 354 patients who had been radiologically diagnosed with torn meniscus and then divided into a surgical and non-surgical group, discovering that not only did the surgical group not do so well, but that they had a high probability of developing an arthritic knee.  Listen to what Ed Susman said the other day in an article written for MedPage Today (Knee Surgery Linked to Higher OA Risk).

“During the previous year, about 4% of the patients in the study underwent knee surgery. All of the 31 knees that showed evidence of osteoarthritis came from the group of patients that had undergone meniscus surgery — 31 of 354 patients. Of the 354 patients who did not have surgery for their meniscus tears, none developed osteoarthritis.  “We found that in a group of patients without osteoarthritis, all knees that developed osteoarthritis within 1 year were among those patients who had meniscus surgery,” he [Frank Roemer, MD, researcher associate professor of radiology at Boston University School of Medicine] said. “We also observed that the risk for cartilage loss was much higher in patients who had knee surgery compared with those who had meniscus damage but did not have surgery.” 

The knee’s meniscus is the the flimsy cartilage “cup” that sits on the top portion of the bones of the lower leg.  The meniscus provides structural integrity to the knee when it is mechanically stressed, twisted, or torqued.   It’s purpose is to disseminate the friction that builds between the upper part of the knee joint (the femur) and the lower portion (the tibia).

Blood flow to all cartilaginous structures is poor, and the meniscus is no different.  In similar fashion to the spinal disc, it is considered to be “avascular” — no blood supply.  If you look at the picture to the left, you will notice where these cup-like meniscus attach (at the center of the knee between the two bony bumps known as condyles).  Because they are not attached at the portions of the knee farthest from the midline, these areas can get over-twisted and tear — particularly at the narrow portion of the medial meniscus where the meniscus is thinner.   Most of the time when doctors tell patients that they have torn a knee cartilage, what they really mean is that they have torn a meniscus.

SOME MORE REASONS TO AVOID MENISCUS SURGERY

  • Just one short year ago in the December 26 issue of the New England Journal of Medicine (Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear), we saw what happened when patients who had dealt with knee pain caused by a torn meniscus for at least three months, but did not have knee arthritis, volunteered for a “new” knee procedure.  Once in the operating room, the surgeon would open an envelope which told them whether to do a real surgery or sham (a fake one).  The fakes were done with real knives and real stitches to create real holes in the knees and real scars.   The study’s conclusions?  “There were no significant between-group differences…   The outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure.


  • And who could forget the study done back in 2008?  Research that was published in that September’s issue of the New England Journal of Medicine (A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee), led the authors to conclude that, “Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy“.


  • Four years before that, back in 2002, NEJM published yet another study on a similar topic (A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee).  The study, done at Baylor University’s College of Medicine, concluded that,  “In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure.”  On top of this, an article from PlaceboEffect.com called Arthroscopic Surgery – Just a Placebo Effect? had some interesting things to say about this study.


“Amazingly, patients who received the surgery experienced exactly the same improvement as those receiving just the incisions – about 50% of patients in both the placebo and surgical group experienced relief overtime. Some of those who experienced relief from the placebo surgery were able to participate in physical activities they hadn’t been able to participate in for years. The renowned arthroscopic surgeon who performed the surgery, Dr. Bruce Moseley, said afterwards, “My skill as a surgeon had no benefit on these patients. The entire benefit of surgery for osteoarthritis of the knee was down to the placebo effect.” The study, which took 10 years to perform and was carefully designed by teams of researchers, rocked the medical world. The researchers conducting the study recommended that doctors no longer perform a surgery they had long considered useful because the effects – while extremely beneficial – were all placebo effects.”

What are my recommendations for someone struggling with knee problems.  Of course it depends on what kind of knee problem it is (HERE, and HERE are a couple of common ones that we deal with here at the clinic).  But for the most part there are some hard and fast rules that make any sort of knee treatment far more effective than it otherwise would have been.

  • CONTROL YOUR WEIGHT:  This is a no-brainer.  If you are OVERWEIGHT OR OBESE, your odds of developing chronic knee problems (including ARTHRITIS) skyrockets as you are forced to deal with the increasing amounts of mechanical stress on the knee(s).  Figure out what it takes to LOSE WEIGHT and get busy.
  • EXERCISE:  There is an old saying in the field of medicine; “motion is lotion“.  You’ve also heard the old cliches “Use it or lose it” and “Move it or lose it“.  Because, as I stated earlier, cartilage is an “avascular” tissue that has little or no blood supply, the only way it gets oxygen, nutrients, and water into its cells, while moving waste products out, is via movement (joint motion).  If the knee is not moving properly, it’s deteriorating.  The key is in performing exercises that don’t repetitively stress the knee such as running on hard surfaces.  More information HERE.
  • CONTROL INFLAMMATION:  This is probably the most important bullet point on the list.  If you are not sure what INFLAMMATION is, make sure to click the link.  If you know what INFLAMMATION is, but aren’t sure how to resolve it, click the link.  HERE is how I would advise you to deal with almost any problem you are dealing with, including knee problems.  Oh; and don’t leave out the PGFO —- it is massively anti-inflammatory.
  • DON’T LEAVE OUT THE COLD LASER:  Cold Laser Therapy is a viable solution for a wide array of health-related problems — including arthritis.  Find out why by going HERE

According to stats from the peer-reviewed literature, currently 70 million Americans are dealing with some degree of arthritis of the knee, and nearly half of all Americans will develop arthritis of the knee in their lifetimes — with the majority by far being women (Journal of Arthritis Care & Research).  It’s time to take the bull by the horns and realize that surgery is not the option that your doctor led you to believe it was.   The truth is, when it comes to knee surgery, EVIDENCE-BASED MEDICINE might not be quite as “evidence-based” as we have been led to believe. 

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