Health Update: Health Update: Some things to know if considering knee surgery – What Experts Say– What Experts Say.
Arthroscopic knee surgery is one of the most commonly performed orthopedic procedures in the United States, and total knee replacement isn’t far behind. Both procedures are frequently recommended for people suffering from knee pain, especially when imaging shows arthritis, meniscus tears, or other degenerative changes inside the joint.
But here’s what many people don’t realize: the presence of those findings doesn’t automatically mean surgery is necessary. In fact, research over the past two decades has repeatedly shown that many knee surgeries are performed on people who could have improved without them.
Let’s start with arthroscopic knee surgery
Arthroscopy is considered minimally invasive. A small camera is inserted into the joint and the surgeon may trim damaged meniscus tissue or “clean up” arthritic debris. Because the incisions are small and recovery is relatively quick, it’s often presented as a simple solution. But research tells a more complicated story.
A landmark study published in the New England Journal of Medicine by Dr. JB Moseley and colleagues compared arthroscopic surgery to placebo surgery in patients with advanced knee arthritis. Some patients received the full procedure – while others only received small incisions without any surgical repair.
The results were surprising. Patients who received the placebo surgery improved just as much as those who had the real operation. Since that study, numerous others have confirmed similar findings, suggesting that for many cases of degenerative knee pain – arthroscopic surgery provides little additional benefit over conservative care.
That doesn’t mean arthroscopic surgery never helps. It simply means it’s often used in situations where other treatments could be just as effective. In some cases, undergoing surgery when it isn’t truly necessary can even accelerate problems inside the knee joint – increasing your likelihood of needing a total knee replacement later on. Which is ironic, since many people choose arthroscopic surgery in hopes of avoiding this major procedure down the road.
Which brings me to total knee replacements – another surgery that has become increasingly common and, in many cases, more avoidable than you might think.
Unlike arthroscopy, knee replacement is a major procedure. The damaged joint surfaces are removed and replaced with artificial components designed to restore function and reduce pain. When performed on the right candidate, knee replacement can be very successful. About 90 percent of patients experience significant improvement, and many implants last 20 years or longer. However, that doesn’t mean everyone with knee arthritis needs one.
One of the biggest misconceptions about knee pain is that arthritis on an X-ray automatically explains the symptoms. What’s not a misconception, however, is that joint degeneration is incredibly common as we age. Studies show that only about 15 percent of people with evidence of knee osteoarthritis actually experience symptoms. The other 85 percent walk around completely pain free despite having the same findings on imaging.
MRI studies reveal similar patterns. In one well-known study published in 2012 – researchers performed MRI scans on more than 500 people who had no knee pain at all. Seventy-two percent showed signs of arthritis and roughly one quarter had meniscus tears. In other words – structural changes inside the knee are more normal than we tend to give them credit for.
This is why basing a treatment decision solely on imaging can be misleading. Over my two decades of treating patients with knee pain – the biggest problems I’ve seen after surgery rarely had anything to do with the procedure itself. Instead, the issue was an incorrect diagnosis going into the surgery. Sometimes the knee wasn’t actually the primary source of pain. Knee pain can originate from the hip, ankle, or even the lower back.
Research has shown that a surprising percentage of people with isolated knee pain actually respond to treatment directed at their spine. That means someone could have arthritis in their knee and still have their symptoms driven by a problem elsewhere. If that underlying cause isn’t identified first – not only may surgery be unnecessary for you – it certainly won’t solve your problem.
Before considering any type of knee surgery – whether arthroscopic or a full replacement – there are several important things to evaluate.
The first is the severity of your pain. If your discomfort is manageable and you can still participate in most of the activities you enjoy – rushing into surgery may not make sense. Even successful knee replacements involve risks such as infection, blood clots, or complications related to anesthesia. And full recovery takes six to twelve months.
The second factor to consider is whether your spine could be involved. If your knee pain fluctuates, appears suddenly, or occurs alongside back discomfort – it is worth having your spine evaluated by someone trained in diagnosing mechanical pain patterns. In many cases, addressing the spinal issue resolves the knee pain without any treatment directed at the knee itself.
Finally, pay attention to how stiff your knee really is. With truly advanced arthritis – stiffness tends to be constant and progressive. But if your knee mobility improves with movement, stretching, or specific exercises – the limitation may be mechanical rather than structural. When that happens – restoring the right movement patterns can dramatically improve symptoms without surgery.
To be clear, I am not saying knee surgery is never appropriate. For some patients – particularly those with severe arthritis and significant functional limitations – knee replacement can be life changing. But surgery should almost always be considered a last resort, not the first step.
Before going down that road, it is essential to make sure your knee pain has been accurately diagnosed and that you have explored all appropriate conservative treatment options. Arthroscopic surgery and knee replacement may be among the most commonly performed orthopedic procedures in the country, but that does not mean they are always the right solution. In many cases, the right diagnosis and treatment approach can restore knee function and eliminate pain without ever needing to step into an operating room.
Dr. Carrie Jose is a Physical Therapy Specialist and Mechanical Knee Pain expert. She owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. For a free copy of her Guide to Knee Pain or information about her upcoming Knee Pain Masterclass, visit cjphysicaltherapy.com or call 603-380-7902.