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  • NYT Article Questions Arthroscopic Surgery, Acid Injections for Knee Pain

    New York Times (NYT) writer Jane Brody engaged in a lot of what she describes as "wishful thinking" about how best to treat her knee pain. One surgery, 1 hyaluronic acid injection treatment, and 2 knee replacements later, she's wondering what might've been had she avoided interventions that "have limited or no evidence to support them."

    In her July 3 NYT piece titled "What I Wish I'd Known About My Knees," Brody recounts her journey through meniscal tear arthroscopic surgery and "painful, costly injections," only to lead to knee replacement, and compares her results with a friend who opted for physical therapy when he was diagnosed with a meniscus tear and is now pain-free. The stories highlight what Brody calls "serious questions" about the benefits of arthroscopic procedures people pursue "in hopes of delaying, if not avoiding, total knee replacements."

    Brody cites recent guidelines, published in BMJ, that recommend conservative treatment over arthroscopic surgery for "nearly all" patients with degenerative knee disease. Brody quotes Reed A.C. Siemieniuk, MD, chair of the BMJ panel that created the new guidelines, as saying that "arthroscopic surgery has a role, but not for arthritis and meniscal tears," and that "[arthroscopic surgery for meniscal tears] became popular before there were studies to show that it works, and we now have high-quality evidence showing that it doesn't work."

    In the article, Brody also summarizes Siemieniuk's recommendations on "approaches that are known to help keep many patients out of the operating room." In addition to weight loss, avoiding activities that aggravate the pain, and using over-the-counter pain relievers if necessary, Brody writes that "most helpful of all" is to "undergo 1 or more cycles of physical therapy administered by a licensed therapist, perhaps one who specializes in knee pain. Be sure to do the recommended exercises at home and continue to do them indefinitely lest their benefits dissipate."

    Comments

    • Speak for yourself!!! Hyaluronic acid injections have eliminated my pain, frequently lasting over a year. My doctor says I am not ready for a replacement because the injections DO work for me. It's amazing since the joints are almost bone on bone. It is people like you, and greedy surgeons who want higher payouts for surgery, who have influenced insurance companies not to cover this godsend medication.

      Posted by Happy Knee on 7/6/2017 9:09 PM

    • I am physical therapist and I agree with the article. Not all can get 0/10 pain from PT but majority of them will. I just recently discharged an obese patient with "bone on bone" knee joint on x-ray. She has no pain if she does her exercises regularly. She tried and worked very hard to avoid surgery or any injections by performing her exercises diligently and she did.

      Posted by Happy knee without surgery or injection on 7/10/2017 3:59 PM

    • Happy Knee's comments are all too typical of individuals who think they are well informed but are actually not and who seek to take the short cut and try to eliminate pain RATHER THAN ADDRESS THE DYSFUNCTION THAT CAUSED THE PAIN IN THE FIRST PLACE!!! The author is only trying to help people like Happy Knee but HK is too foolish to recognize that. Plus, the so-called "greedy surgeons" also make very good money from injections, probably more on a per unit time basis than surgery with less work and less risk. Plus, most insurances DO cover hyaluronic acid injections. But beyond that, has HK considered use of manual therapy and neuromuscular re-education to achieve proper accessory and physiological mobility and proper neuromuscular control of the knee? Has the knee and areas proximal and distal to the knee (including the spine and the "spinal engine" contra-rotational mechanism) been addressed with regards to mobility, strength, endurance, neuromuscular control, etc? Has HK learned how to sit, perform the sit-to-stand, stand, walk, climb stairs, squat, etc. correctly? Has HK learned how to properly use his feet, hips, and the rest of his body? Has HK learned how to protect the knee and what to do and what not to do? Has HK reduced his body weight to the optimal level? Does HK understand an anti-inflammatory diet and does HK understand the chondrogenic and anti-inflammatory effects of various nutraceuticals? Does HK even understand the NLP/neuromarketing/trigger function of the phrase "bone-on-bone"? My guess is that HK ignorant of many if not most of these things. It's unfortunate but ignorance of these areas is epidemic and not easily overcome due to the programming most people have inadvertently fallen prey to. Sadly, Happy Knee will probably wind up with total knee replacement 5 to 10 years down the road.

      Posted by Brian Miller on 7/12/2017 9:01 PM

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