Health Alert 22
New studies have shown that two surgeries done on many thousands of people have a similar problem. The problem is – they don’t work.
Have you ever been advised to have surgery? It can present a dilemma. On the one hand, you want to take action and do what is necessary to preserve your health. On the other hand, surgery requires the ultimate in acceptance of a passive role. You must have faith in your surgeon’s consultation. He is the expert. But we all know that the surgeon also benefits from the procedure.
This problem may be bigger than we have known. Two well-controlled studies were conducted separately. Both came to the same distressing conclusion.
The new studies evaluated the effectiveness of two surgical treatments for arthritis of the knee.
1) Arthroscopic lavage and debridement.
2) Tidal irrigation.
The two surgeries focus on the same idea. Knee pain is caused when the cartilage in the joint becomes rough. Fragments of cartilage and calcium irritate the joint causing inflammation and pain. Lavage, debridement, and irrigation surgeries are techniques for cleaning this debris out of the joint.
The concept makes sense. But, evidently, these surgeries have become quite common before anyone ever proved if they actually worked. Hopefully, these two new studies will inform doctors and patients alike.
* Procedures No Better Than “Sham Surgery” *
The first study looked at arthroscopic lavage and debridement (N Engl J Med 2002; 347(2): 81-88). 180 patients with at least 6 months of pain and medical therapy were recruited for the study. The patients were randomized into 3 groups: arthroscopic lavage, arthroscopic debridement and sham surgery groups. The study was blinded, so none of the patients knew which surgery they received.
People in the sham surgery group actually had a fake surgery. They were given an IV tranquilizer and an oxygen mask. Skin incisions were made to simulate those of the true surgery. Neither the patients nor the postoperative staff knew who had real and who had fake surgeries.
Pain and performance levels were measured 7 times over 2 years (walking speed, stair climbing). There was no more improvement in the 2 surgery groups than in the sham surgery group.
The second study examined tidal irrigation surgery. (Arthritis Rheum 2002; 46(1): 100-108) 180 patients were also used in this study. The patients were randomized into 2 groups: people who got tidal irrigation surgery and those who had a sham surgery.
In the sham surgery, a needle was passed through soft tissue but not all of the way into the joint capsule. This mimicked real surgery. The patients were unable to tell if they had real surgery or sham surgery.
Function, swelling and pain were assessed at 3, 6 and 12 months after the surgery. Again, there was no difference between those who had surgery and those who didn’t.
The number of people having these worthless surgeries is alarming. Instead of proving the surgery doesn’t work after it has already been performed many times over, doctors must prove that a surgery works before making it a public service.
* Your Alternatives to Surgery *
So, what do you do if you have osteoarthritis knee pain? First, if you have an acute injury to your knee, you may need an orthopedic surgeon. For chronic, longer-term problems, a surgical approach should be the last alternative. Here are some more natural solutions to try first.
? Non-weight bearing exercise. Note: If you have arthritis in your knees, do not go out and walk or jog for exercise. This will only make the problem worse. You need a type of exercise that will allow inflammation to subside and prevent further wear and tear from overuse. Swimming is excellent. Bicycling and controlled strength training are good.
• Weight loss. Like so many problems in medicine, optimizing your weight may allow your body to heal itself. See Health Alerts 18-21 for a plan for fat loss.
• Supplements. Don’t bother with calcium pills. They won’t help. You can reduce inflammation with white willow tea. You can get it at nutrition stores. Try a cup after breakfast and at bedtime. You can help rebuild the joint with MSM (methylsufonlymethane) and glucosamine. You can find them in combination. You need at least 200 mg of each. You can increase them up to 1000 mg of each. They may take several weeks to have their full effect.
Al Sears, M.D.