Knee Relief May Be All in Your Head

A surgical procedure used to treat arthritis of the knee may bring patients relief, but the relief may all be in patients' heads, new research results suggest.

In a study of 180 people with osteoarthritis of the knee, a team of Houston surgeons found that patients who had ``sham'' arthroscopic surgery reported as much pain relief and improved mobility as patients who actually underwent the procedure.

In fact, the group that did not undergo surgery reported better short-term functioning compared with the other patients, Dr. Bruce Moseley Jr. reported here at the annual meeting of the American Academy of Orthopedic Surgeons.

Arthroscopic surgery for arthritis of the knee involves removing damaged tissue from the joint through small incisions. It has been unclear why the procedure helps some people with the condition. So Moseley and his colleagues at Baylor College of Medicine decided to test whether there might be an arthroscopy-associated ``placebo effect''--a psychological lift that makes patients feel better physically.

In research, drugs are commonly tested against inactive pills to gauge the placebo effect, but in this case, Moseley's team led patients to believe they underwent surgery. The surgeons made small, skin-deep incisions in the patients' knees and basically ``acted out'' the surgery, Moseley explained.

After 2 weeks, patients who got the sham surgery were doing better than the true surgery patients--most likely, Moseley said, because they had been spared the ``trauma'' of surgery. He reported that after 2 years, the groups had made similar gains in walking and stair climbing, and their pain had eased to comparable degrees.

Because all patients had received painkilling drugs and none underwent physical therapy after their actual or sham surgery, Moseley credited the placebo effect for helping the sham-surgery group.

``I was surprised,'' he said, noting that when colleagues first proposed the possibility to him, he discounted it.

``But,'' Moseley added, ``every treatment has a specific effect--the physiological effect, and a non-specific effect--an emotional or psychological (benefit).''

While this research is not the final word on arthroscopic surgery for knee osteoarthritis, Moseley said the result does suggest it may be time for surgeons to take a closer look at it.

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