The pain in my knee is no joke. When something starts to happen, patients save themselves with injections, arthroscopy and other procedures that are supposed to bring relief quickly. But are they really working?
Are orthopedists needed in the health service? It’s a provocative question, but it’s also popular with some doctors. Of course, we need traumatologists and trauma surgery specialists to fix broken bones and bring accident victims to order. But orthopedists who heal shoulders, knees or the cross so that we feel worse after treatment than before? – without such doctors, some patients would also like to do.
Take the knee, for example. Various manipulations, injections and arthroscopes are not only good for the joint, but also cause more harm than good. Although the knee may hurt sharply in the event of overload, incorrect footfall or wear, it is often better not to pack needles and other tools inside the joint. How sensitive knee injections can be, Boston doctors found out in the Journal of the American Medical Association. Orthopedists and rheumatologists at Tufts University investigated how the knee injection of cortisone works in osteoarthritis. Injections of this anti-inflammatory substance are a popular remedy for ailments related to wear and tear in the joint. When a joint hurts because it has become inflamed and a hematoma is forming, many orthopedic surgeons rely on cortisone.
The benefits of this therapy, however, are modest. In a recent study, 140 patients with an average age of 58 years were given either cortisone injections or a saline placebo every three months. After two years of therapy, cortisone patients were not in any better condition. They complained of similar pains and ailments as patients receiving saline. Neither could they boast of better mobility and function of the knee, nor of the distance they were able to cover on foot.
In addition, there was a significant difference in patients taking cortisone: their articular cartilage had shrunk compared to the control group. Cartilage shrinkage is a symptom of worsening osteoarthritis. “The results of our study do not support the treatment of osteoarthritis patients with cortisone,” said Timothy McAlindor, lead author of the study. According to the doctor, it cannot be ruled out that the severity of the symptoms decreased during the three-month period between treatments. Overall, however, there is no apparent benefit to the patient.
Treating inflammation in the knee sounds theoretically meaningful. After all, inflammatory processes and the immune cells activated as a result of these processes cause changes in the tissue, as a result of which the delicate joint capsule and cartilage degenerate faster. In this case, however, cortisone therapy causes the knee to become weak. “Probably the loss of cartilage is a side effect of cortisone,” the authors speculate.
“Cortisone definitely does not help in the treatment of osteoarthritis of the knee,” says Peer Eysel, head of orthopedics and trauma surgery at the university clinic in Cologne. – This measure destroys the cartilage and can permanently damage it. It may provide temporary relief, but it is purely symptomatic, just as it is with painkillers. Eysel remembers an almost 80-year-old patient who suddenly had sharp pains in his knee on the eve of his scheduled departure. – I gave him an injection, but it should remain the absolute exception – says the GP. – After all, any injection into the knee carries the risk of infection, especially in the case of cortisone, as it weakens the body’s defenses.
Intra-articular injection of cortisone or hyaluronic acid brings short-term relief at best, but increases the risk of exacerbation in the long term. Additionally, this procedure must be performed under completely sterile conditions, as arthritis is difficult to heal. The joints have poor blood supply, so antibiotics hardly reach them. In extreme cases, it may result in stiffening of the joint. This dangerous complication also caused a stir 15 years ago by other research results. In 2002, Bruce Moseley from Houston showed that in the treatment of osteoarthritis, placebo treatment gives exactly the same results as the popular arthroscopy.
The orthopedist divided 180 patients with osteoarthritis into three groups. One was incised swollen, and the joint was cleaned and rinsed. The other group only had a knee rinse. In the third group, the patients only had their skin incised and the sounds of the alleged surgery were heard from the tape. During the first few days, the complaints decreased in all three groups – the most in the placebo group. However, within a month and a half, the symptoms worsened again. Half a year, a year and two years after the surgery, all patients complained of knee problems to a similar degree. Sham surgery turned out to be the same as a true colonoscopy.
“The most important message is that when cartilage is damaged, it is damaged,” Dr. Eysel says. – Drilling holes in the bones in the hope that this stimulus will build replacement tissue is exactly the same as laser physiotherapy and similar procedures. The progression of osteoarthritis cannot be stopped in this way. Arthroscopy is necessary in the event of joint blockage, meniscal rupture or diagnosis of bone fragments in the joint. According to experts’ estimates, in the past years 80 percent. these procedures were performed unnecessarily. – Thanks to the development of the magnetic resonance technique, colonoscopy of the joint just to see what is happening is not necessary – says the head of the doctor.
Despite the scientifically proven ineffectiveness of this method, it was not until 2015 in Germany that arthroscopy was abandoned as the standard procedure in the treatment of osteoarthritis, which can only be explained by pressure from various interest groups and other absurdities of the health care system. “In the case of the examined arthroscopy procedures in osteoarthritis of the knee joint, no evidence was found to confirm their validity compared to placebo procedures” – concluded the relevant decision-making body.
So should orthopedists leave our knees alone, and should patients hope that the ailments will go away on their own over time? After all, experienced doctors know that also in the case of low back pain 90 percent. of them disappear on their own and no x-rays, injections or surgery are needed. For knee problems, weight loss and adjusting the activity – for example, cycling instead of jogging – advises Dr. Eysel. – Movement and a painkiller will help soothe you from time to time. Any invasive procedures should be approached with caution, because they usually do not give anything. Only in the event of acute and persistent symptoms, can an artificial knee joint be considered as a last resort.
In general, however, the rule should be: doctor, please leave my knee alone, because you can overdo it and harm the patient. “It’s definitely a problem,” Eysel confirms. – Our healthcare system has its strengths and weaknesses, but I prefer it to the situation in England, where many patients do not receive the necessary care and sometimes have to wait a long time for any treatment.