Partial removal of the kneecap is harmful, a Finnish study reveals

According to a recent Finnish study, surgical cleaning of the arthrodesis does not improve patients’ knee symptoms or functional ability, but causes harm in the long term.

In the ten-year follow-up, more symptoms, lower functional capacity, more progression of osteoarthritis and a higher probability of subsequent knee surgeries were observed in the patients who underwent surgery compared to the placebo group.

Research appeared Wednesday in The New England Journal of Medicine.

The operation is based on the idea that the pain on the inside of the knee is caused by a tear in the internal meniscus, which can be treated surgically.

“Such reasoning based on biological plausibility is common in medicine, but in this case it does not stand up to critical scrutiny,” says the study’s second principal investigator, a specialist in orthopedics and traumatology Raine Sihvonen From the Ficebo research group (Finnish Center for Evidence-Based Orthopaedics) of the University of Helsinki.

Several randomized studies have previously shown that partial removal of the IUD has not improved patients’ symptoms.

Cutting in Finland has decreased significantly in recent years due to research evidence, but procedures are still widely performed around the world.

Registry and follow-up studies published in recent years have raised concerns about the possible harms of the surgery. Based on them, the partial removal of the coil is associated with an increased risk of joint replacement surgery and a potentially higher risk of complications after joint replacement surgery.

In a recently published Finnish study, patients with degenerative helix rupture were randomized to partial helix removal or placebo surgery. In addition, the patients were monitored for ten years, an exceptionally long and comprehensive period.

“The result is the first to directly show a cause-and-effect relationship between the procedure and the subsequent harms,” ​​says the leader of the study, professor of orthopedics and traumatology Teppo Järvinen.

Järvinen says that this is an example of the so-called medical reversal phenomenon, where a widely used treatment turns out to be ineffective and potentially harmful.

“Several independent treatment recommendation organizations have recommended for almost ten years that the procedure should be abandoned. Yet, for example, the American Orthopedic Association has still considered the surgery to be justified. This reflects well how difficult it is to abandon ineffective treatments,” says Järvinen.

According to him, there is a human reason for that.

“Who among us likes to admit they are wrong?”

The US health care system rejects the evidence also because the procedure generates billions in revenue for doctors and hospitals. Orthopedic associations, on the other hand, are defenders of orthopedists’ interests, says Järvinen.

Even in Finland, surgeries that have proven to be useless have not decreased uniformly, but there are differences between regions big differences.