Finnish researchers have shown just one of the most common surgical procedures in the Western world is unnecessary. Keyhole surgeries of the knee are useless for patients whose knee complaints are due to joint abnormalities associated with aging. The results of the FIDELITY trial have been published in the esteemed New England Journal of Medicine.
The 65-year-old South Korean woman had previously been diagnosed with osteoarthritis, a condition in which the cartilage and bones within the joints degrade, causing pain and stiffness. But when pain relievers and anti-inflammatory drugs didn’t alleviate the pain in her knees and only caused stomach discomfort, she had turned to acupuncture, the doctors wrote last week in the New England Journal of Medicine. Acupuncture is an alternative medical practice that uses needles to purportedly stimulate certain points on the body, to …
The Finnish Degenerative Meniscal Lesion Study (FIDELITY) compared surgical treatment of degenerative meniscal tears to placebo surgery. A year after the procedure the study participants, both those in the group who underwent surgery and those in the placebo group, had an equally low rate of symptoms and were satisfied with the overall interests of their knee.
To be considered….
Knee problems – ones associated both with trauma and with aging – are highly common and place a significant load on the health care system. The most common diagnosis of the knee that requires treatment is a tear in the meniscus, for which the established form of treatment is the partial withdrawal of the meniscus through keyhole surgery (I.e., Arthroscopy; a minimally invasive surgical procedure under which an examination and sometimes treatment of damage of the inside of a joint is performed using an arthroscope, a type of endoscope that is embedded in the joint through a small incision [ Wikipedia ]).
People with knee arthritis are doing a lousy job of getting exercise, according to a new study. That’s not a huge surprise. Who wants to run with aching knees? It’s human nature to want to coddle aches, not exercise them. But exercise is actually good medicine for osteoarthritis. It is proven to reduce pain and inflammation, makes it easier to move, and can prevent or delay disability. Alas, the people with knee arthritis tracked in this new study are not doing …
Most of the treated meniscal tears are degenerative. This means that the tear was not caused by a traumatic incident on a healthy knee, but normal ageing.
Previous randomised studies have shown that keyhole surgery on the knee doesn’t alleviate the symptoms of patients who suffer from osteoarthritis – whether the surgery would be appointed for a meniscal tear or another complaint – and as a result, keyhole surgeries on arthritis sufferers have become less common. At the same time, however, the number of partial meniscectomies has increased significantly, even though proof of the effects of the surgery on the symptoms has been lacking.
The goal of the FIDELITY trial was to see whether keyhole surgery to partly remove the meniscus (arthroscopic meniscal resection) is an effective form of treatment when the tear is caused by degeneration.
The study included 146 participants, ranging between 35 and 65 years of age. The study participants were arbitrarily assigned to undergo either an arthroscopic partial meniscectomy or placebo surgery where the procedure was simulated. In the simulated procedure, the patient’s knee was manipulated and instruments associated with meniscectomy brought to the exterior of the knee, giving the patient an impression of a normal procedure. No one engaged in the study (including the patients, the people involved in their care after surgery, and the researchers who analysed the results) knew whether the patient was in the meniscectomy or placebo group.
A year after the surgery, the patients were asked about the healing of the knee, symptoms they had experienced, and their satisfaction with the treatment and its results. The patients were also asked which group they believed they had been in and whether they would be ready to choose the treatment they had received, if they were required to make the same decision as they did in the preceding year.
In both groups, most patients were satisfied with the state of their knee and believed their knee felt better than before the procedure. Of the patients who underwent the partial meniscectomy, 93% would choose the same treatment, while 96% of the people in the placebo group would choose the same.