Does Scoping Knees Help Arthritis?

Arthroscopic knee surgery for people suffering from osteoarthritis is a popular treatment but according to a new study published in the New England Journal of Medicine, knee arthroscopy doesn’t actually reduce joint symptoms or improve function when compared with nonsurgical treatment.

Canadian researchers examined the effectiveness of arthroscopic surgery, the process of making small surgical incisions and inserting a thin, flexible fiber-optic scope and other small instruments into the knee joint to remove pieces of cartilage and smooth the joint surfaces. Arthroscopy is used to repair osteoarthritis as well as other knee problems.

The study treated 178 patients with moderate to severe osteoarthritis of the knee and an average age of 60 years old.  All patients recieved physical therapy and medications such as ibuprofen or acetaminophen but 86 of the patients also received arthroscopic surgery. They were then tracked for two years.

The researchers found that both groups of patients experienced similar improvements in joint pain, stiffness, and function.  At the end of two years, the researchers concluded that compared with nonsurgical treatment, arthroscopic surgery of the knee did not improve joint symptoms or function for people suffering from osteoarthritis of the knee.

It is important to note that the study focused on arthritis-related knee problems — arthroscopic knee surgery is still beneficial in other conditions that affect the knee, such as meniscal and ligament problems.

Patients who have a combination of knee problems, such as osteoarthritis and a meniscal tear might also respond better to arthroscopy.

Source: Kirkley, A. The New England Journal of Medicine, Sept. 11, 2008; vol 359: pp 1097-1107.

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Nature vs. Nurture – What do twins tell us about back pain?

See the MRI’s here?  It’s an office worker on left and truck driver on right. Twin siblings 56 years old. They show high degrees of similarity in disc degeneration despite high differences in their lifetime physical exposure to loading.

The findings of the Twin Spine Study, an ongoing research program started in 1991, have led to a dramatic paradigm shift in the way disc degeneration is understood.  In the past, the factors most commonly suspected of accelerating degenerative changes in the discs were various occupational physical loading conditions, such as handling of heavy materials, postural loading and vehicular vibration.

Drawing on information from 600 participants in the population-based Finnish Twin Cohort–147 pairs of identical and 153 pairs of fraternal male twins–the Twin Spine Study has turned around the “injury model” approach to disc degeneration.

Researchers from Canada, Finland, the United States and the United Kingdom compared identical twin siblings who differed greatly in their exposure to a suspected risk factor for back problems; for example, one of the twins had a sedentary job while the other had heavy occupational physical demands, or one routinely engaged in occupational driving while the other did not. The studies yielded startling results, suggesting that genetics play a much larger role in disc degeneration than we previously thought. 

The findings indicated that while physical loading–handling heavy loads, bending, twisting and static work in awkward postures–appears to influence disc degeneration, the effects are very modest. The Twin Spine Study is far from over: having found evidence that genetics may play an overlooked role in disc degeneration, the team of North American and European is now working to identify the specific genes and biological mechanisms influencing disc degeneration and back pain problems; understanding how degeneration progresses over time; and differentiating normal, inconsequential changes from degenerative changes that lead to pain.

What’s the take home point here?  I think it’s not that your life can be a physical loading free for all and the stressors you put on your spine don’t matter — they do.  Trauma and repetitive strain can certainly have an effect on the degenerative process.  However, family history is more likely than once thought to be a risk factor for spinal problems — or resistance to spinal problems.  In other words, if you are among the 20% of the population who does not experience some form of low back pain in their lifetime, thank your genetics (and your parents).

 

Dr. Brett L. Kinsler is a chiropractor serving the greater Rochester NY area.

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