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Osteoarthritis: is surgery the answer?

Arthroscopic surgery for knee osteoarthritis is a growing bone of contention.

Osteoarthritis is very common in Australia – in fact, it affects 1.9 million, or one in 11 Australians and is the nation’s leading cause of chronic pain and disability.

Unsurprisingly, it costs the health system a lot – an estimated $3.75 billion annually – but research suggests that much of that cost may be going towards unnecessary knee surgery.

In the past, knee arthroscopy has been commonly prescribed to treat knee osteoarthritis when patients aren’t responding to other treatments. But the evidence doesn’t necessarily stack up.

A small 2002 study examined the effectiveness of knee arthroscopy for osteoarthritis by comparing the results of patients who received the procedure with those who received a placebo procedure. It found the surgery was no more effective than the placebo.

Since then, the evidence has grown. A 2016 systematic review of the benefits and harms of knee arthroscopy did not support the use of arthroscopic surgery in middle-aged and older patients with knee pain and degenerative disease. And a 2016 Finnish study further challenges the commonly held belief that an arthroscopy can help people who experience mechanical knee issues such as joint catching or joint locking via partial removal of a torn meniscus.

Many clinical guidelines, like the Australian Commission on Safety and Quality in Healthcare’s Clinical Care Standards, have recently been updated to reflect this research.  But, what does it mean for patients?

Medibank Clinical Adviser Sue Abhary said patients play an important role in driving better management of osteoarthritis.

“We know that alternative treatments like exercise, maintaining a healthy weight and pain medication can be used to effectively manage osteoarthritis in a lot of cases. If you are suffering from knee osteoarthritis, make sure you ask your doctor about these options before agreeing to surgery.”

“It’s also important to ask your doctor about the potential risks, chances of success and alternatives to any surgery before deciding to go ahead.”

Dr Abhary said the Medibank Better Health Foundation is working to be a catalyst for positive change, with a particular focus on the management of osteoarthritis.

“The foundation is investing in research and using that research to promote healthy behaviours, inform policy and improve clinical practice.”

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