Arthroscopic Surgery for Degenerative Knee Disease Called into Question

. November 1, 2017.

According to Chad Terhune, Kaiser Health News, “Some experts estimate that at least $200 billion is wasted annually on excessive testing and treatment” of patients.

Dr. Atul Gawande, a surgeon and author, in a New Yorker article stated that, “Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm.”

The Lown Institute describes reasons for overuse of medical treatments:

Indication creep— when a drug or treatment is used for healthier people after it has been used for sicker patients.

Preference misdiagnosis— physician uses a remedy preferred by him/her instead of that which is the very best for the patient.

Fear of lawsuits if drug or treatment not used.

Patient demand for a particular drug or treatment.

Financial needs of hospitals and doctors causes unnecessary remedies to be used.

Tests called into question by the American Board of Internal Medicine Foundation include PET scans to diagnose Alzheimer’s, MRI for lower back pain, Colonoscopy after 75, the PAP smear every year instead of every three, and the yearly physical.

One procedure that has gained increasing attention in recent years because of apparent overuse is arthroscopic surgery for degenerative knee disease (AKS). This procedure is performed more than 2 million times a year across the world and costs more than $3 billion annually in the United States.

Researchers from multiple institutions, as reported in the May 2017 issue of the British Medical Journal, have come to the conclusion that knee surgery “does not, on average, result in an improvement in long term pain or function.”

Degenerative knee disease, according to the authors, involves a patient with knee pain that has at least one of the following characteristic:

  • Evidence of osteoarthritis
  • Meniscus tears
  • Locking, clicking or other mechanical knee symptoms

Dr. Glenn E. Whitted, an orthopedic surgeon, works at the Toledo Clinic where he performs arthroscopic surgery of the knee, among other procedures.

Whitted states “most general orthopedists would agree, from their own experience, that arthritic patients do not do especially well with a knee scope, regardless of diagnosis, unless they have a very prominent mechanical component of knee trouble.”
Whitted is aware of some doctors who use knee pain and “the most minor of MRI findings” to select patients for AKS. “Many people fail treatment under these conditions … since the treatment doesn’t fit the problem,” he explains.

According to the British Medical Journal article, AKS can also result in other negative outcomes:

  • Significant cost
  • Follow-up wound care
  • Follow-up physiotherapy
  • Recovery of two to six weeks
  • Time off work
  • Driving limited
  • Avoidance of strenuous activity

Whitted does feel that, in many cases, injection therapy with cortisone or lubricants as well as physical therapy can be very helpful. Knee replacement is a possible option if other strategies are not successful.

When confronted with the possibility of arthroscopic knee surgery, also consider the less traumatic procedures mentioned above.


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