It's been nearly a decade since Western University researchers reported that arthroscopic knee surgery provides no additional benefit compared to optimized physical and medical therapy among sufferers of osteoarthritis (OA) and yet the surgery is still routinely performed internationally.
Now the investigative team from Western's Bone and Joint Institute is hoping their latest study, which analyzes the cost-effectiveness of the procedure, will make a broader impact on the health care community given its implications on the value of treatments for the more than 250 million people worldwide affected by knee OA.
Jacquelyn Marsh, Trevor Birmingham, Robert Giffin and their collaborators suggest that given the similarity in outcomes at the end of the two-year study, it is highly unlikely that arthroscopic knee surgery is cost-effective compared to non-operative treatments, that included physical therapy, exercise and medication.
"Patients who received non-operative therapies showed similar improvements in pain, function, and quality of life compared to those who also received surgery, at a significantly lower cost," says lead author Jacquelyn Marsh, a Post Doctoral Fellow in Health Economics at Western's Faculty of Health Sciences.
The findings were published in a study titled "Cost-effectiveness analysis of arthroscopic surgery compared with non-operative management for osteoarthritis of the knee" in the prestigious journal, BMJ Open.
"We previously showed in a randomized clinical trial that arthroscopy for knee osteoarthritis provided no benefit over optimized non-operative care. Despite that finding, and subsequent similar studies, the surgery is still commonly performed," says Birmingham, the Canada Research Chair in Musculoskeletal Rehabilitation at Western's Faculty of Health Sciences. "That's why we felt it was important to do the accompanying cost-effectiveness analysis, often not considered necessary when clinical effectiveness is not shown."
Birmingham notes that most people do feel better after knee arthroscopy - the catch is that randomized clinical trials show that similar patients also improve to a similar extent when they receive non-operative treatments (usually exercise therapy) or 'sham' surgery (where the patient receives anaesthesia but doesn't actually receive the surgical treatment).
"When that body of evidence is coupled with the present economic analysis, one has to question whether health care funds would be better spent elsewhere," says Birmingham.