Common Orthopedic Procedure May Not Be Beneficial

Performed more than two million times per year around the world, knee arthroscopy is the most common orthopedic procedure. An international panel has released a new guideline in the British Medical Journal recommending that patients with degenerative knee disease should not waste their time on this procedure, which offers only minimal benefits. This overuse of knee arthroscopy is found in the United States, Canada, Australia, Denmark, the United Kingdom, and other industrialized countries.

The guideline applies to patients with arthritis, meniscus tears, sudden pain, and mechanical symptoms (clicking and catching in the knee). Studies of over 1.8 million patients found that those receiving surgery do not see much improvement if any at all compared to those who use exercise, weight loss, medication, or other less invasive treatments. The American Academy of Orthopedic Surgeons agrees with the findings, yet cautions that there are always exceptions. There will be times when the procedure is completely appropriate.

Another study in 2016 found that patients with degenerative medial meniscus tear did no better after surgery than those who had physical therapy. Arthroscopic surgery is still performed on patients with degenerative knee disease. The procedure costs the American health care system $3 billion per year and is still recommended around the world.

The surgery may persist due to financial incentives to physicians, patient frustration with conservative treatments, and not incorporating new evidence into current practice. The American Academy of Orthopedic Surgeons is working on their own set of guidelines for patients with meniscus tears and other problems. There may be a small role of financial incentive by surgeons, it doesn’t explain the wide extent of the overuse. Most likely, it is a result of a failure to incorporate new evidence into clinical practice.
Ross, Casey. “This orthopedic surgery is the world’s most common. But patients rarely benefit, a panel says.” STAT, 10 May 2017. Web. 11 May 2017.

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