A recent report in the Medical Post July 30, 2002 demonstrated that knee surgery (arthroscopy) is no better than a sham (fake) procedure at relieving the symptoms of osteoarthritis.
The study, performed by Dr. B Moseley and colleagues at the Baylor College of Medicine in Houston, randomized 180 patients with osteoarthritis of the knee to one of three treatment groups: two different knee surgical procedures and a placebo procedure.
The one hundred and sixty-five patients who completed the trial were followed for two years and assessed on five self reported scores, three for pain and two for function, as well as, one objective test of walking and stair climbing.
At no point did either surgical group have greater pain relief or improvement in function than the placebo group. In fact walking and stair climbing were worse in the surgical group than the placebo group at two weeks and one year and showed a trend toward worse functioning at two years.
These results were published in the July 11 issue of the New England Journal of Medicine.
The study has been criticized by Canadian Orthopaedic Surgeons who suggest that the study had biased forms of osteoarthritic knees known not to respond well to surgery. The researchers contend that this is untrue.
Prior to any surgical procedure all conservative means of intervention should be explored.
The problem is that the medical profession and the public are not aware of the effectiveness of treating pain/discomfort by biomechanical correction of joints and muscle with manipulation. Certainly manipulation’s successful role in neck and back pain by a chiropractor is well established in the scientific literature; refer to Newsletter #1, low back pain and manipulations; Newsletter #2, neck pain and manipulation, Newsletter #3, stiff neck may cause stiff hip, more on back pain, knee pain and pelvic joints, Newsletter #4, for your information back pain, whiplash, Newsletter #5, pain, spinal manipulation and beyond, Newsletter #6, world leading back pain guidelines, cost of lower back pain, Danish Guideline, Newsletter #7 whiplash, chiropractic and headache and ankles, Newsletter #8, spinal Manipulation and the risk of spinal manipulation.
For example, a seventy-five year old retired school teacher presented with osteoarthritis of the right knee. She had injured this knee as a child and throughout her life she experienced progressive discomfort to the point where she could no longer bend the knee past 45o which caused her significant discomfort and restricted activity.
She indicated that she didn’t want to use drugs nor did she wish to pursue surgery. She also noted that she experienced hip and leg pain from time to time.
Examination revealed sacroiliac dysfunction on both sides of her pelvis, i.e. an unstable pelvis, as well as, a weak right hamstring muscle and an overly tight ilio-tibial band and vas medialis (these are the muscles on the upper leg on either side of the knee). As well, these muscles were quite tender in response to probing indicating muscle strain. (This strain would be a protective mechanism due to the pelvic instability creating the weakness in the hamstring muscle which stabilizes the knee when the heel contacts the ground).
After these findings were explained she revealed that her knee over the years had been going out from under her, i.e. buckling with no apparent warning. Again, this is due to the irritation to the sciatic nerve root because of the pelvic joint dysfunction or instability creating a local tissue inflammation resulting in nerve root irritation and as previously indicated the subsequent weakness of the hamstring muscle. Of course, this type of motion dysfunction accelerates wear and tear of the knee, a progressive development towards osteoarthritis.
To summarize treatment: the pelvis was manipulated to correct the joint motion which restored the pelvic stability and hamstring strength, the involved muscles were manually stimulated to remove the strain. She was shown exercises to do at home to aid this process over six to ten treatment visits. As a result the hip, leg and knee discomfort subsided and she now has almost complete flexion in the involved knee.
Over the several years since this lady first successfully responded to care she has had several relapses. On these occasions she again underwent joint and muscle manipulation and was encouraged to begin the exercises again. And again she favourably responded. However, on the last visit she remarked that perhaps she will start to check in every one to three months for maintenance care. As always, maintenance is easier than repair.