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Women And Arthritis Sufferers Have Poorer Short-term Recovery From Arthroscopic Knee Surgery
11-Jul-2007
Science Daily
The factors associated with poor short-term recovery from knee surgery
appear to be different than those found to mar long-term outcome from
the same surgery, according to new research released at the 2007 Annual
Meeting of the American Orthopaedic Society for Sports Medicine at the
Telus Convention Center (July 12-15). Over 600,000 arthroscopic knee
procedures are performed each year. Factors such as age, obesity, and
amount of tissue removed are known to be related to poorer long-term
outcomes.
New research identifies gender (being female) and having osteoarthritis
as two factors predictive of poorer short-term outcomes after
arthroscopic knee surgery.
"We found that women showed poorer short-term recovery than men in the
first year following arthroscopic meniscal tear removal surgery, and
people with osteoarthritis also did not do as well as others," says
principal investigator Peter Fabricant, BS, a medical student at Yale
University School of Medicine in New Haven, Conn. "The factors
associated with a poorer long-term outcome, such as larger tear size,
greater amount of tissue removed, advanced patient age, and higher Body
Mass Index, are not the same as those we can associate with short-term
surgical recovery."
The meniscus is the shock-absorbing tissue that cushions the knee joint
preventing the bones from rubbing. Tears in this tissue can cause pain
and loss of function. In arthroscopic partial meniscectomy, the surgeon
inserts small surgical instruments and a camera through tiny incisions
in the knee to remove torn tissue. An estimated 636,000 arthroscopic
knee procedures are performed annually, according to the American
Academy of Orthopaedic Surgeons.
Fabricant and colleagues at Yale University studied 126
patients who underwent arthroscopic partial meniscectomy to assess the
impact of obesity, age, gender, amount of tissue removed, and
degenerative joint changes on short-term recovery. They found that
being female and the extent of osteoarthritis were associated with a
less-than-optimal first-year recovery.
Other studies have shown that advanced age, obesity, and the amount of
meniscal tissue removed all negatively affect long-term outcome from
arthroscopic meniscal repair. "In our study these variables did not
affect short-term recovery. Conversely, gender and osteoarthritis
appear to play a role in short-term recovery, as they have been shown
to do in the long-term," Fabricant comments.
The current medical literature only offers research
findings on long-term outcomes following arthroscopic meniscal repair.
"We couldn't find anything in the literature to predict recovery during
the first year," explains Fabricant. "Physicians need to be able to
discuss with patients how long it might be before they can return to
optimal function levels in work and activities of daily living."
Fabricant and colleagues suggest that severe osteoarthritis in the knee
may be a contraindication to surgery. "Arthritis may be a marker for a
degenerated knee, which may not be able to recover as well as a
healthy, non-arthritic knee," Fabricant says.
Osteoarthritis may also be a marker for worse overall
knee function in general. Patients with severe osteoarthritis already
have loss of cartilage and soft tissue. Further tissue removal appears
to have minimal impact on patient knee pain and function during the
year following surgery.
The investigators say that it is unclear exactly how
female gender complicates surgical recovery. Fabricant notes that there
are gender differences both in surgical outcome and possibly in the
biomechanics resulting in how the knee was initially injured. Even
before surgery, women typically reported more knee pain and decreased
knee function compared to men.
Note: This story has been adapted from a news release issued by American Orthopaedic Society for Sports Medicine.
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