Weak at the knees
February 23rd 2017, 18:10
At any moment, up to a third of us are struggling with pain in our knees. In a major US National Health Interview Survey in 2006, nearly a third of adults reported experiencing some type of joint pain, with more than a sixth reporting pain in the knee. The situation is even worse in the UK, where major surveys in Bristol and Nottingham both estimated that up to a quarter of all adults suffer with chronic knee pain, while a Greater Manchester survey brought that figure up to nearly one-third of all men and women over the age of 45.
Even in China, knees are the most commonly reported parts that hurt and, indeed, with age the world over, the incidence of knee pain is only going in one direction.
Ask your doctor why and he'll invariably point to age-related 'wear and tear'. Not much can be done for these worn-out joints, says medicine, other than to make you more comfortable with painkillers and other drugs until you're an acceptable candidate for surgery.
First stop on the surgical highway is arthroscopic surgery, where areas of 'redundant' cartilage and inflamed tissue are removed. Last year, some 650,000 people in the US alone were offered this surgery, even though there's never been evidence to suggest the procedure either cures or arrests the osteoarthritic process.
In one study of 180 patients, one group was given the surgery, another was given a similar operation and a third was given a sham operation—the patients were surgically prepared, placed under anaesthesia and wheeled into the operating room where incisions were made in their knees, but no actual procedure carried out.
Over the next two years, during which time none of the patients knew who'd received which kind of treatment, all three groups reported moderate improvements in pain and function. In fact, the group who'd had the fake operation reported better results than some who'd actually undergone the real one. The mental expectation of healing was enough to marshal the body's healing mechanisms—and it was these that produced the physical improvements, not the surgery itself.
But so ingrained is the idea that joints simply erode away with time that your doctor is bound to start urging you to have replacement surgery once you hit age 55. Some half a million knee replacements are performed in the US every year, and this figure is set to increase by an incredible 673 per cent over the next two decades, according to the American Academy of Orthopaedic Surgeons.
The medical research claims an astonishing success rate for 95 per cent of knee operations, with the majority remaining functional for at least 10 years.
But that impeccable track record refers simply to the knee replacements that 'take' while carefully omitting the overall complication rate of nearly one-fifth, which can include deep-seated infections, pulmonary embolism (obstruction in a blood vessel going to the lungs), deep venous thrombosis (blood clot in a vein), nerve damage to a limb or elsewhere and even, in extremely rare cases, permanent injury to a foot or loss of a limb.
The fact is, doctors rush in far too quickly to replace knees. As new research has recently uncovered, some one-third of knee replacements in arthritis sufferers shouldn't have happened in the first place, while the need for such surgery was debatable in a further 22 per cent. The report from the Virginia Commonwealth University in the US concluded that only 44 per cent of procedures were fully justified.
Impose those percentages on the 80,000 knee replacements carried out in the UK and the 600,000 carried out in the US every year, and you come up with the incredible statistic that more than 340,000 of them may not have been necessary.
Florida pain specialist Dr Mitchell Yass, for one, is convinced even that's an understatement. Dr Yass is one of the few outliers who believes that worn-out joints are rarely the source of pain. Yass has treated more than 14,000 patients and, in 95 per cent of cases, he says, the knee joint itself, even when severely arthritic, was not the problem.
Instead, in virtually every instance, what was presenting as knee pain was actually being caused by a muscle imbalance around the knee, creating misalignments that eventually translate into pain. When patients were treated with simple exercises, as described in our cover story this month (page 40), the pain invariably disappeared.
Knee pain is yet another instance where doctors believe that a problem can only be sorted by some sort of heroic intervention. As with so much in life, the answer is often easier than you think.