A study has found that surgery is no better than more conservative treatment to relieve knee pain caused by arthritis. In the study, being published Thursday in The New England Journal of Medicine, 86 patients who had the operation fared no better over two years than 86 who had physical therapy and took medications to dampen inflammation. The results of the study are in line with those from a study published in 2002. But experts are divided about what effects the two studies will have. Some say the new study just confirms what they already knew. Others say they hope that doctors who did not believe the 2002 study will be persuaded by this one to stop doing the operations. The 2002 study, by the Department of Veterans Affairs, had a different design: instead of assigning patients to surgery or medical treatment, it assigned them to real surgery or a sham operation. The real surgery was found to be no better than the sham one. That study was denounced by many orthopedic surgeons, but Medicare decided in 2003 to stop paying for the operation. Still, because doctors can be reimbursed for the procedure by modifying what they say is the patient’s problem, it is not clear whether most doctors stopped doing the operation, or how many such operations are being done. There is no national system for keeping track. The surgery involves making small incisions in the knee, inserting an arthroscope to see the joint, and then flushing debris from the knee or shaving rough areas of cartilage and cleansing the joint.
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