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Top Doc: Many Knee Replacement Surgeries Unnecessary

Top Doc: Many Knee Replacement Surgeries Unnecessary
(Sopone Nawoot/Dreamstime)

By    |   Friday, 04 January 2019 10:20 AM

The rate of knee replacement surgery doubled from 1999 to 2008 and experts expect that Americans will have about 3.5 million of the procedures a year by 2030. But the dramatic rise in surgery is not only due to our aging population and obesity, it’s fueled by doctors who stand to make big bucks.

Although most knee replacement surgeries are successful, some doctors are increasingly concerned that the procedure is overused and that its benefits have been oversold.

“We do too many knee replacements,” says Dr. James Rickert, president of the Society for Patient Centered Orthopedics. “People will argue about the exact amount” but few people will dispute that too many are performed.

According to AARP magazine, research suggests that up to one-third of those who have their knees replaced continue to experience chronic pain, while one in five are outright dissatisfied with the results.

A study published in the British Medical Journal found that knee replacement had “minimal effects on the quality of life,” especially for patients with less severe arthritis.

According to a 2014 study published in Arthritis and Rheumatology one-third of patients who undergo knee replacement may not even be appropriate candidates for the procedure because their arthritis symptoms are not severe enough to merit this aggressive intervention.

There is a trend to offer knee replacements to younger folks, in their 50s and 60s, who are suffering due to sports injuries. However, in all likelihood these will have to be revised in the future as even the newer implants last only 20 years, says Rickert, an orthopedic surgeon in Bedford, Indiana.

He points out that over time, the implants can loosen and detach from the bone causing pain. The plastic components of the artificial knee also can slowly wear out, creating debris that causes inflammation and more pain. Patients who are overweight or obese after surgery can put extra pressure on implants, making them wear out more quickly.

Rickert says that money can be a strong motivator for a doctor to advise knee replacement surgery, which can cost around $31,000.

“Knee replacements are crucial to the financial health of hospitals and doctors’ practices,” says Rickert. “The doctor earns a lot more if they do surgery.”

In a recent study published in Osteoarthritis and Cartilage, researchers compared surgical and nonsurgical treatments in 100 older patients eligible for knee replacement.

Over two years, all patients improved, whether or not they had surgery. Those who had immediate knee replacement surgery, had twice the improvement than the group who chose non-surgical intervention such as taking over-the-counter pain remedies, listening to dietary advice, and receiving physical therapy and education about their condition.

But surgery also carried risks. Surgical patients developed four times as many complications including infections, blood clots of knee stiffness severe enough to require another major procedure.

The most important conclusion of this study, however, is that most of those treated with non-surgical interventions were satisfied with their progress and although all study participants were eligible to have knee replacement surgeries, two-thirds chose not to have it after all.

Dr. Rickert shares these tips with Newsmax readers:

  • First and foremost, patients should be certain to express their preference for nonoperative care clearly when they meet their health care providers.
  • Be prepared to have a conversation about nonsurgical treatment options. These can be highly effective.
  • Physical therapy, exercise programs, weight loss and patient educations have been as successful in reducing pain as non-opioid medications.
  • Avoid treatment that is not evidence based. For example, knee arthroscopy for arthritic knee pain has been shown to be an ineffective treatment.

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The rate of knee replacement surgery doubled from 1999 to 2008 and experts expect that Americans will have about 3.5 million of the procedures a year by 2030. But the dramatic rise in surgery is not only due to our aging population and obesity, it's fueled by doctors who...
knee replaceent, surgery, unnecessary
Friday, 04 January 2019 10:20 AM
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