July 15, 2002

SURGEONS BRING PATIENTS TO THEIR KNEES

THE UNTOLD STORY OF HOW DOCTORS PLAY ROULETTE WITH YOUR KNEES

By Nicholas Regush

We learned last week that arthroscopic surgery on banged up knees is more or less worthless. For some, that must have come as a shock; for others, particularly more appraising researchers who have been eyeballing this rather lucrative area of orthopedic medicine, the results of the study published in the New England Journal of Medicine pretty well confirmed long-held suspicions that early improvement, when it did occur after surgery, usually didn’t last.

And why not? One major reason, unfortunately not discussed enough, is that knee surgery, as it is usually conducted, is primitive. The surgeon simply does not understand enough about the dynamics of the individual’s knee to be able to do refined work.

What is needed is a lot more information about internal knee mechanics. At Columbia University, for example, a biomedical engineering team led by Van C. Mow, has developed computer software that allows a surgeon to view a patient’s knee in 3-D.

The pictures are generated via an MRI.

What the scientists see on a computer screen is a dynamic engineering model. It is an accurate representation of the entire knee. Geometry, math equations and physical laws are built into the mathematical model, making it true-to-life.

What all this amounts to is a virtual knee, a simulation model that would enable a surgeon to do extremely accurate work on a particular person’s knee, with the understanding of the various forces acting upon it and its various limitations.

A surgeon could actually work on this model and determine what type of surgery might work best on that particular knee and then do the actual surgery.

This is a far cry from the widespread stab-in-the-dark kind of work going on in today’s operating theaters.

Little wonder that the study also found that sham knee surgery is as effective as the real thing.