GPs debunk arthritis surgery

At best, surgery is a placebo and puts patients at risk of complications: report.

osteo knee

The recommended treatments for osteoarthritis (OA), which affects about 60 per cent of Australians aged over 55, is set to undergo a radical change.

Surgery, opioids, glucosamine, stem cell therapy, insoles and acupuncture are out and regular exercise, weight management and cognitive behavioural therapy (CBT) are in.

These are the recommendations in a new report from the Royal Australian College of General Practitioners (RACGP).

As the population ages and obesity rates continue to rise, the number of Australians with OA is expected to jump from the 2.2 million in 2015 to almost 3.1 million in 2030, according to the Guideline for the management of knee and hip osteoarthritis. It says direct healthcare costs for OA were about $2.1 billion in 2015, but that will rise to $2.9 billion by 2030. It puts the “broader economic costs” at about $22 billion annually.

The report strongly warns against surgeries such as arthroscopies and cartilage repairs, unless there is evidence of a “locked knee”.  It says there is mounting evidence that these surgeries are “at best placebo and at worst put patients at risk of serious complications”.

It also says complementary and alternative therapies, including glucosamine, vitamin D, acupuncture and electrotherapy, “should not be offered” and gave therapeutic ultrasound and shockwave, laser and cold therapies only “conditional” support.

In its uncertain category are tailored footwear, bisphosphonates, anti-nerve growth factor and omega 3 fatty acids. It says it can make no recommendations for collagen, avocado, soybean, pine bark extract and turmeric.

OA is a chronic disease that mainly affects the knees, hips and hands. It occurs when the cartilage – the protective layer that covers the ends of bones – wears down. When there isn’t enough cartilage at the joints and the bones rub against each other, it causes pain and limits the range of motion.

RACGP president-elect Dr Harry Nespolon told The Age that exercise is now the "front-runner” ahead of surgeries and medications.

For all people with knee OA, no matter what age, the report strongly recommends land-based exercise, particularly walking, muscle-strengthening exercises and Tai Chi, as well as stationary cycling and hatha yoga.

It also recommends land-based exercise for sufferers with hip OA, but says “the type of exercise that is most beneficial is not yet known”.

People with OA who are overweight should follow their doctor’s guidelines, it says, but aim to lose a minimum of five to 7.5 per cent of their body weight.

The report took aim at costly imaging – in particular ultrasound, MRI and CT scans – which it said were not needed to diagnose OA. It recommends imaging only if OA affects a person very quickly or gets worse very quickly.

“OA is a really hard and terrible illness for people to have,” Dr Nespolon says.

“The problem is most of the treatments we've got are pretty poor, so naturally people go looking for any treatment that might help. But really they'd be better off spending their money on something else.

“Glucosamine is a classic example. People take it year after year, but there's no good evidence that it changes the course of OA.”

If you have OA, does this report encourage you to adopt a different treatment method? Have you already gone down the path of surgery? Was it successful?



    To make a comment, please register or login
    31st Aug 2018
    With severe degenerative osteo arthritis in both knees, spine, both shoulders first appearing 20 years ago I am well aware of all the treatment options "recommended" or promoted over time. Forget cortisone injections, Synvisc injections, fish oil, creams, gels, platelet rich plasma injections, surgery and pain medication too!! Apart from surgery, have been down all the other paths and they do not work. For any pain relief to be effective in my situation, I would lose my independence, that is no longer be able to drive, think clearly and rely on others for a lot of daily household assistance! I do not want to become a zombie!
    I have had great relief from rhizotomy, the benefits last from between 6 - 12 months. A simple, fast procedure where the peripheral nerve endings are "burnt" to stop the brain receiving the constant pain signals. It allows one to move more freely, be more active (without going "overboard") and all round improves one's mental and physical health.
    31st Aug 2018
    Sounds like a good development. If you deaden the nerve will that mean the person is more likely do keep pushing on with bone on bone friction?
    31st Aug 2018
    Rosret, I can only assume you are being sarcastic in your response! Do you really believe that a person who has bone on bone severe pain/condition would be so stupid to suddenly "think" they could run a marathon, climb a ladder, dig in the garden?????
    This treatment only relieves the patient of the constant and incessant strong pain messages received in the brain, it does not alleviate the condition whatsoever!
    To be able to perform the limited daily tasks in the usual slow manner without those incessant pain signals is of great benefit!!
    I am not about to do anything which will accelerate the degeneration and I doubt anyone of sound mind would either!
    31st Aug 2018
    osteo arthritis is either not permanent or likely to be permanent its not a disablity its a medical condition says the NDIS. That's why theres so much I cant do now ( or I can but my joints tell me not to) I peel vegies and end up peeling my fingers when they cramp up etc I started gaining weight when I started on anti depressants , ive tried dieting etc nothing works. doc said its a trade off , the pills or …………….
    3rd Sep 2018
    tisme Disability SA will only help people with the other form of arthritis, Osteo arthritis is not manageable when you can not do every day tasks and require help. Medical system must change their outlook,
    Dave R
    31st Aug 2018
    I find taking one 200mg Celebrex once a day for two or three days settles down my arthritis whenever it flares up. I take about thirty capsules a year. Also keeping warm helps me a lot and living in far north Queensland is a great way to never get really cold.
    31st Aug 2018
    If there wasn't such a yin and yang with Celebrex it would have to be the wonder drug.
    If I need my joints to work for the day its my magic pill and I treasure each one like its gold.
    31st Aug 2018
    How is it that glucosamine is not supposed to help when if I stop taking it the lumps on my fingers redden up and start to ache after two or three weeks?
    31st Aug 2018
    You are one of the people it worked for. The only thing it did for me was lighten the load in my back hip pocket.
    31st Aug 2018
    Same as fish oil capsules TonyW, they are supposed to be useless but my wife takes them for joint pain in the elbow and when she stops taking them, the pain returns. My only answer is some things must work for some people and not others. Happiness is the absence of pain.

    31st Aug 2018
    I have a good GP who keeps up-to-date with medications for my OA. When the pain becomes too much I take some anti inflammatories which cannot be taken all the time because of side effects. Interestingly, I asked my GP about glucosamine and he said it works but only if I had started taking it when I was a teenager. For those who don't have OA, it is painful, restrictive and incurable and there are different levels of it. In my case, I put up with it and don't complain because there are a lot worse things that can happen to people.
    31st Aug 2018
    After putting up with pain for three or four years I had the torn cartilage in my knee repaired. I have never had even the smallest twinge of pain since. I’m very glad I had it done.
    Golden Oldie
    31st Aug 2018
    I take glocosamine, chondroitin and MSM in tablet form at the recommended quantity, and one capsule of 1000mg of Krill Oil and it keeps the pain away. At one time, my preferred glucosamine mixed tablet was unavailable, and had another another recommended by the pharmacist, the quantity of glucosamine was the same, but not the chondroitin and MSM. It was cheaper, but not nearly as effective, suffered more pain and stiffness. Happy to be back on the more expensive one .
    31st Aug 2018
    Just for interest in hospitals in Paris Osteoarthritis is being eased for at least 95% of sufferers using safe, easy to use, low cost, Non Transdermal Phototherapy patches. These same patches are available in Australia, are accepted by the TGA here and the medical authorities in all the 100+ countries the patches are available but I guess until the medical system here is allowed to even suggest an alternative many will still be continue to suffer unnecessarily? The patches by the way are safe for ALL ages. No drugs, no chemicals and NO harmful side effects - EVER!. Find out more about these patches, they are a blessing for millions of people around the world already.
    31st Aug 2018

    "Summary: There is no need to read this entire post, it is long and full of science. If you want the take home message, then here it is. Lifewave patches are placebo. In other words, they are very expensive pieces of gauze with a sticky bit. If someone has told you that they cure certain conditions, then you should ask them for evidence, since there is nothing to show that these patches work, none, ever. They are making it up, or they are deluded, or they are lying. You decide. Search for evidence. I bet you don’t find it."

    Unfortunately Rob is an advertiser. He often appears on these pages advertising "cure."
    31st Aug 2018
    You are so far OFF the mark it is terrible Jennie. But wish you well with your comments.
    Maybe when the Lifewave business opens in King William Road next month helping people suffering with chronic pain and others issues you can pop along and tell all the people exiting the place that it is "All in THEIR minds". Sorry for the feedback but it is so sad to see people who know NOTHING about something rejecting it and steering others away from it just because they feel it does not work. I do hope we can meet someday, have a coffee together and explain more for you.
    31st Aug 2018
    It sounds too much like a pyramid scheme, Rob.
    31st Aug 2018
    Still an advertiser though Rob!
    31st Aug 2018
    Yes Triss, but would appear rather strange that they are used in hospitals in Europe and a are primary product for use with disaster victims around the world, including even the fire victims here in Victoria. Pyramid schemes do not exist here, they are illegal in case you did not realise it? This is new technology supported by a Mistry of health so you are way off course with your assumption.
    1st Sep 2018
    Sorry everybody, I was only trying to suggest that anybody with pain issues, loss of cartilage or other problems such as Osteoarthritis at least consider the proven alternative I speak of. I am NOT trying to sell the product; there are already hundreds of thousands of members of the company around the world including Australia where you can obtain the patches from - AND EVEN THEN, you can generally TRY before you buy, NO OBLIGATION. Because the patches work so quickly you will know in a couple of minutes IF they are for you. And ALL that is DONE WITHOUT CHARGE. So before you consider all this a SCAM, RIP OFF, SOMETHING IMPOSSIBLE or the craziness of Pyramid selling or whatever - Think again!
    If in Adelaide check out the Lifewave establishment in King William Road opening later this month. How genuine can it get for goodness sake!
    31st Aug 2018
    I have significant osteoarthritus in my left knee following a serious accident in the mid 1970's. The first operation was in 1978 and the second in 1996. At that stage the orthopaedic surgeon said I would need a knee replacement within 10 years. I take anti-inflammatories on a regular basis and am physically very active (climbing Kilimanjaro, trekking to Everest Base Camp plus others in the past six years) and attend a gym about five days a week. When I am Orienteering, I wear a knee brace for support (the brace is not worn on any other ocassion but is carried as a back up when I am travelling.

    I accept that at some stage I will probably have a knee replacement - probably when I cannot control the pain through other means.

    I have had one hip replaced twice - the first had problems some years after the initial one and in this case surgery was the only option as pain was significantly greater when moving. There has been a marked reduction in pain since the initial surgery and I was able to do things that previously were not possible for a while (Kilimanjaro and the Himalayas took place after the first hip replacement.
    31st Aug 2018
    oseoarthritis is often the result of some type of injury of deteriorate and need repair or replacement. Especially if the sufferer can't sleep even with prescribed painkillers and his/her leg will not bend at all, even with intensive physiotherapy and exercises. Bone scraping against bone did not respond to any types of treatment, natural or otherwise. Some joints actually fill with fluid and have to be drained by inserting as special needle etc.
    ray @ Bondi
    31st Aug 2018
    I have had a knee replaced and it was the best thing I ever did, no pain and I am nearly back to what I could do before, karate and running is out sadly out but all other pursuits are as normal, what, is this government propergander again, the government does not want to fund the hospital or medical system in any way, this is rubbish, I KNOW operations on the knee work, at least for me, what is this suggesting I should have lived out the rest of my life not being able to walk and have great difficulty getting out of a chair, sure that is how I want to live NOT.
    31st Aug 2018
    Can we have the age of people suffering from the complaints listed below and the lifestyle that might have contributed to these as otherwise we don't know whether to expect these at iat our age or not.
    31st Aug 2018
    Sorry for mistakes, first comment, rectified now, happy day to you all.

    Can we have the age of people suffering from the complaints listed above and the lifestyle that might have contributed to these as otherwise we don't know whether to expect these at our age or not.
    31st Aug 2018
    Oh I do feel so left out in these 'woe is me' articles where we get to compare our respective; op's, ailments, afflictions, aids, pills and snake oil charms and thus succinctly detail the mysticism of associated cures (or lack of). Keep it up folks, you've probably got the quacks already online ordering their next model Benz (-ee-knees).
    This topic hot on the heels of Euthanasia - overwhelmingly voted in the affirmative - has me wondering when most you lot are gonna call it a day, hey? Good health.
    1st Sep 2018
    Some people can get relief simply by cutting out meat, dairy and wheat. All these are acid forming foods which increase inflammation. Eat lots of berries which can be helpful too.
    3rd Sep 2018
    The note below is typical of what we do in PROMOTING the patches - WE DO NOT charge for our time or travelling costs and the patches are provided for FREE to try without obligation!!!!!
    If not sure what the Lifewave patches are doing toward many severe and chronic issues, then maybe this would help understand a little?
    The message below is from a lady who had been suffering with several chronic pain conditions.

    “On Friday morning, my back and both knees were aching so bad and they were all about an 8/10 pain score. After having the patches applied on Friday at about 2.30pm, I went to the shops for a couple of hours (which would normally leave me aching all over) and had forgotten about the patches altogether.
    I got into my car at 5.15 and leaned over to put my handbag on the passenger seat and then grabbed the steering wheel to help me sit back up again properly. That’s when I was shocked out of my mind to discover that my back pain had disappeared. Then when I got home and got out of the car, I noticed that my left knee wasn’t hurting, and that my right knee pain was down to about a 2/10.
    During that week, my sleep was atrocious (due to pain) and I had been averaging about 2 hours per night. Except for Thursday night where I had no sleep at all.
    I went to bed at around 10pm and slept so deeply and soundly for 36.5 hours straight!!!
    I woke up completely confused due to losing a whole day, but I must’ve really needed it”.

    We first met this lady that day on Friday 31st August 2018
    We patched her with a pair of Ice Wave patches under the feet on Kidney 1 points along with an X39 Stem Cell patch on the back/base of neck on the C7 (GV 14) position.
    These 3 patches would normally have cost around $5 each Retail or much less as a member of Lifewave.

    Over the weekend we also presented the patches at a large meeting in the Barossa to explain about and demonstrate the patches. We had over 95% success rate in easing many issues with several people there. The patches are successfully giving people their lives back without the use of harmful drugs, chemicals or risky procedures.
    They are NOT promoted toward the Treatment, Cure or Prevention of any disease or named medical issue but can be used toward the resulting conditions and this is where the patches produce the amazing results. Hoping this will satisfy the comments of people in these forums?
    4th Sep 2018
    We are in the exercise and fitness business. We have clients who arrive with bad knees, bad backs etc and within a few months they leave much healthier, fitter and full of life.

    Personally, I would not recommend your patches because I am of the firm opinion one can get better results from moderate exercise, a reasonably fat free diet and generally a positive lifestyle,
    6th Jun 2019
    Thank you to all those who have posted on this forum. You have given me a few ideas. I have osteoarthritis but only in the knees/legs (and one shoulder which hardly worries me at all). Not in the hands, thank goodness. One of my legs is slightly bent and most of my pain comes from this. The pain is often in the thigh/lower hip area. I was due to have a knee replacement in February 2013 but elected not to go through with it. I am now 71 years old.

    One thing I have found that works is panadol osteo. I do not take it regularly as recommended but I find that if I already have a lot of pain, take two tablets then have a rest for a while, that it does work. Also, taking it with a cup of coffee helps too.
    4th Nov 2019
    For the past 8 months I have been on the exercise-based GLAD program offered through my local community health centre. Osteoarthritis in my knees flared up during a holiday in late 2018. Until then Glucosamine daily had kept arthritis pain at a minimum for many years. For a couple of months I hobbled around and worried about causing further damage. Then my GP suggested I get assessed by a physiotherapist. She suggested the GLAD program and within a month of starting the program pain in my knees had reduced significantly. Over the following months I built up muscle strength in my legs and core strength for balance. I won't give up. The benefits have been wonderful and no further medication was required.

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