When you experience crippling knee pain, should you get surgery right away or should you try physical therapy first? A new study published Tuesday in the New England Journal of Medicine suggested that it might make sense to go for the non-invasive option first.
A principle investigator and the director of Orthopedic and Arthritis Center for Outcomes Research for Brigham and Women’s Hospital (BWH), Dr. Jeffrey N. Katz said, “Since both the patients who received physical therapy and those who received surgery had similar and considerable improvements in function and pain, our research shows that there is no single ‘best’ treatment.”
The BWH team studied 351 patients over age 45 who had serious knee pain, ending up with 330 active participants. They were randomly assigned to have immediate arthroscopic surgery to repair the tear in the knee’s cartilage or else to begin with physical therapy (PT) instead. The PT group was allowed to request the surgery later if they felt they needed it, which 30 percent elected to do before the six month trial was complete.
At the end of the test, both groups showed the same amount of improvement. Getting the surgery sooner didn’t mean that a patient ended up with more function or less pain than the other patients. However, trying physical therapy first meant that some patients were able to achieve the same level of healing without getting surgery at all.
Since the knee surgery can cost several thousand dollars more than PT while exposing patients to the risks of complications, PT can present some advantages to people who are willing to do the work.
The problem of crippling knee injuries is a recurring one in sports. A National Institutes of Health report said that they account for 15-50 percent of sports injuries in young people under age 20. They also frequently interrupt or end an athlete’s career.
We’re repeatedly told to exercise, but crippling knee pain is one problem that can come from overuse rather than from resting.
Dr. Katz will present the research today at the annual meeting of the American Academy of Orthopedic Surgeons.
It should take the pressure off doctors and their patients to know that delaying surgery to try physical therapy won’t make crippling knee pain worse.
[knee X-ray courtesy Dr. Henry Gouvas and Wikipedia Commons]