Meniscectomy, Knee Replacement Outcomes and Take-Home Messages

Around 700,000 arthroscopic partial meniscectomies are done each year in the United States at a cost of about $4 billion, yet surgery plus physical therapy works no better than physical therapy alone and was not superior to sham surgery. A 2017 guideline strongly recommends against arthroscopy in nearly all patients with degenerative knee disease. Knee replacement is considered when several criteria are present, such as severe pain limiting daily activities, pain at rest, deformity and failure of conservative care. Between 10 and 34% of patients report an unfavorable pain outcome afterward. A meta-analysis of 32 studies identified more pain sites, higher preoperative pain, catastrophizing, depression and anxiety, and poorer function as predictors, with obesity raising complication risk. Addressing these before surgery may help. The take-home messages: osteoarthritis is multifactorial, the body can still adapt, education and reassurance are central, and exercise, physical activity and weight management are first-line care. Most supplements and injections lack solid support.