Robert Litchfield realizes getting surgeons to stop performing arthroscopic knee surgery on arthritis patients will be an uphill battle.
Fowler Kennedy Sport Medicine Clinic Medical Director Robert Litchfield shares alternative treatments for osteoarthritis of the knee at a major symposium.
An orthopedic surgeon himself, Litchfield jokes “it is like the butcher talking about the merits of a vegetarian diet.” Somewhat in spite of his profession, Litchfield is championing alternatives to the commonly used surgery for arthritic knees.
“As a surgeon, it is easier to sign someone up for a surgery than to spend a few minutes telling them why they don’t need surgery,” he says.
Litchfield, Medical Director of Fowler Kennedy Sport Medicine Clinic, offered a keynote address last week at the second annual symposium, Bridging Partnerships in Aging and Rehabilitation Research, hosted by the Faculty of Health Science and the Program in Aging, Rehabilitation and Geriatric Care.
According to Litchfield, half of the population will have arthritis by the age of 65, mostly due to sport traumas, bone bruising or obesity.
Many are looking for a quick fix to relieve joint pain and each year thousands of Canadians turn to surgery.
“I think we live in a society where everyone is looking for a quick fix,” he says. “They do expect surgery … to get them better quick.
“Maybe we are too quick at the gun and we forget about all the other options that may be available.”
Litchfield co-authored a landmark study by The University of Western Ontario and Lawson Health Research Institute published in the New England Journal of Medicine.
The study demonstrated patients who received arthroscopic surgery to treat osteoarthritis of the knee did not have significant improvement over counterparts who received only medication and physical therapy.
The investigation, funded by the Canadian Institutes of Health Research, showed surgery was ineffective at reducing joint pain or improving joint function.
“We found no real difference between the groups,” says Litchfield.
The exception was members of the surgery group who showed signs of the “placebo effect of surgery,” saying they felt better after the operation.
Both surgical and nonsurgical study participants received patient education, had regular contact with a nurse, physiotherapy, given recommendations for a weight-loss program and follow-up visits. Some patients used anti-inflammatory medication.
“I think we have a lot of work to do to figure out the right combination,” he says. “It is difficult to determine who would benefit greater from surgery.”
Nonsurgical options include: weight loss, changing footwear, bracing, health food supplements, strength training, hyaluronic acid injections (a naturally-occurring lubricant material), acupuncture and medication. Further research needs to be done to explore the impact of nonsurgical treatments, adds Litchfield.
One challenge will be spreading the word to frontline nurses and doctors, and other healthcare providers to recommending alternative treatments.
“The knee is the area where we see the biggest challenges because it is such a frequently involved joint and also because our surgical management of the knee has not been perfected to the same degree as, says, a hip,” he says.
In December 2008, the American Academy of Orthopedic Surgeons added a recommendation against performing arthroscopy on patients with osteoarthritis of the knee in its Treatment of Osteoarthritis of the Knee Guideline.
In spite of the mounting evidence against arthroscopic surgery for treating arthritic knees, Litchfield doesn’t feel this will leave operating rooms empty. Instead, there will be a shift in treatment.
“What we are going to see is a change – a different operation,” he says, adding the focus will be on treatments that will have more a lasting change, such as cartilage transplantation.
More than 130 people registered for the symposium.
Speakers also covered topics on mobility and aging; building capacity through community-based aging and rehabilitation research; evidence-based practice, from bench to bedside; adding quality to years; activity and mobility across the lifespan; and psycho-social determinants of health and aging.