REPORT: Americans undergo half-million unnecessary knee surgeries...

lane

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http://www.breitbart.com/system/wire/upiUPI-20131230-012138-9240

This was lifted directly from Drudge Report, which describes a NEJM article that uses the new gold standard of medical efficacy, patient satisfaction.

http://www.nejm.org/doi/full/10.1056/NEJMoa1305189


BACKGROUND
Arthroscopic partial meniscectomy is one of the most common orthopedic procedures, yet rigorous evidence of its efficacy is lacking.


METHODS
We conducted a multicenter, randomized, double-blind, sham-controlled trial in 146 patients 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis. Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery. The primary outcomes were changes in the Lysholm and Western Ontario Meniscal Evaluation Tool (WOMET) scores (each ranging from 0 to 100, with lower scores indicating more severe symptoms) and in knee pain after exercise (rated on a scale from 0 to 10, with 0 denoting no pain) at 12 months after the procedure.


RESULTS
In the intention-to-treat analysis, there were no significant between-group differences in the change from baseline to 12 months in any primary outcome. The mean changes (improvements) in the primary outcome measures were as follows: Lysholm score, 21.7 points in the partial-meniscectomy group as compared with 23.3 points in the sham-surgery group (between-group difference, −1.6 points; 95% confidence interval [CI], −7.2 to 4.0); WOMET score, 24.6 and 27.1 points, respectively (between-group difference, −2.5 points; 95% CI, −9.2 to 4.1); and score for knee pain after exercise, 3.1 and 3.3 points, respectively (between-group difference, −0.1; 95% CI, −0.9 to 0.7). There were no significant differences between groups in the number of patients who required subsequent knee surgery (two in the partial-meniscectomy group and five in the sham-surgery group) or serious adverse events (one and zero, respectively).


CONCLUSIONS
In this trial involving patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure. (Funded by the Sigrid Juselius Foundation and others; ClinicalTrials.gov number, NCT00549172.)
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The scary thing about this is (as always) the Comments section of the article, which has more than its fair share of Average Joes complaining about those greedy doctors, how they had surgery and hurt afterwards, and how anyone could allow these unnecessary procedures (a la the headline) to be performed. It also makes me wonder about the NEJM publishing something like this with such a dearth of objective medical data on a relatively small number of patients.

What say you?
 
OP
lane

lane

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You seem to be mocking patient satisfaction. Wouldn't that be the reason for having an elective orthopedic procedure?
Why not just prescribe a day at the spa if the ultimate goal is just satisfaction?

This is a poorly designed, underpowered study that found its way into the mainstream media, which is now deeming elective knee scopes as unnecessary because of the placebo effect.
 

urge

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Why not just prescribe a day at the spa if the ultimate goal is just satisfaction?

This is a poorly designed, underpowered study
How did you arrive at these conclusions?

I'm sure patients will be very happy about their day at the spa. Not sure how that would change how they rate their knees 6 months down the road. You could do that study if you think it is relevant.
 

nimbus

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There was a similar, smaller study back in the nineties comparing sham vs real surgery for degenerative meniscus disease with the same result. Not sure why this is news.

Also remember a study comparing 3 treatments for hnp. Discectomy vs chiropractic care vs counseling and a back health pamphlet. No difference in long term outcome. That is why it is appropriate that patients who end up in our care have jumped through so many hoops before ever getting to us.
 

Silent Cool

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Next up is wisdom teeth. How many kids (and adults) are subjected to unnecessary wisdom tooth removal? 3K for a set of 3rd molars? The incidence of 3rd molar pathology is about the same as the incidence of appendix pathology. About 12-15%. But we don't remove appendices prophylactically the way we often do wisdom teeth.

Why?
 
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nimbus

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Next up is wisdom teeth. How many kids (and adults) are subjected to unnecessary wisdom tooth removal? 3K for a set of 3rd molars? The incidence of 3rd molar pathology is about the same as the incidence of appendix pathology. About 12-15%. But we don't remove appendices prophylactically the way we often do wisdom teeth.

Why?
There are a lot of unnecessary tooth extractions.

I went to a orthodontist who believes in preserving teeth whenever possible....which is most of the time. I still have all my teeth....and my appendix.
 

Silent Cool

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There are a lot of unnecessary tooth extractions.

I went to a orthodontist who believes in preserving teeth whenever possible....which is most of the time. I still have all my teeth....and my appendix.
Yup. I saw a news special awhile back re: tooth extractions for orthodontics. It's scary how many people's faces have been screwed up b/c of tooth extractions for ortho. I got a consultation once for ortho and the dr. wanted to remove a tooth. "No thanks." I found a different orthodontist and, surprise surprise, no tooth extraction needed! What a racket.