Apr 17, 2018

Where There’s A Kneed There’s A Way

Often times when us humans are in pain or discomfort, we look, quite understandably to measures that we think will help us the quickest, with the least amount of resistance and inconvenience.

When the grandkids have been keeping up a chorus of ‘I’m hungry, I’m hungry, no thank you, brussel sprouts shan’t suffice oh forgiving grandparent, pick something else’, for the last two hours on a Monday night, it’s almost a noble strategy of survival to embark on an option many have had before you, “takeaway”.

And not just any takeaway, takeaway with big fat veggies amongst the curry and noodles.

You’ve heard everyone raving about it.

Yet with any solution that seems too good to be true this usually bellies the deflating reality of, well, it isn’t.

Knee surgeries have been on the rise among seniors across the world and new research from scientific bodies are displaying worrying statistics of ineffectiveness and data disregard.

It is estimated that around 750,000 procedures on knees are conducted on seniors each year in the US and numbers in Australia are showing parallels.

With a price tag of $10,000 per surgery this trend is causing serious concern among many experts in the field.

Martin Makary, a professor of health policy at Johns Hopkins Medicine in Baltimore has outlined some of his concerns regarding the procedure and how frequently it is conducted, “It’s known that this procedure is often done without strong evidence; I don’t think it’s well known that this is one of the most common surgeries in the U.S.”

knee surgery

In his recent study shown in the Journal of the American Medical Association Surgery Makary outlines why the study has gleaned the concerning information and the ramifications of the situation, “We not only described it, we looked at it in a population every American pays for (through Medicare). That’s a price tag and a context I’m not sure people have really calculated.”

From the lack of care, attention and scientific approach in suggesting knee surgery for patients to the ineffective outcomes on the other end, the study has brought to the fore the waste of money, time and hope this trend is causing.

Researchers at Johns Hopkins Medicine say that money could better spent on alternative treatments, from simple non-invasive measures like Advil to more intricate courses of physical therapy that will yield patients better and more sustaining results.

The problem lies in the type of meniscus tear that can occur within the knee.

David Altcheck, an attending orthopaedic surgeon at New York’s Hospital for Special Surgery and the medical director for the New York Mets explains that only one out of the two tears, the far less common one, responds to surgery.

Arthroscopic procedures (invasive inner knee surgery) for acute injuries produce satisfying results in conjunction with physical therapy due to the fact that these injuries usually occur in younger patients and occur in an instant while the meniscal injuries in seniors are usually the result of wear and tear and often occur alongside osteoarthritis.

Altcheck highlights that cartilage that is worn out in seniors differs from what is damaged in acute injuries.

The cartilage that causes issues for older patients is regularly articular cartilage while younger patients injure meniscal cartilage.

Suffice to say without going too deep down the technical route is that Arthroscopic meniscal surgery often times cannot effectively repair degenerate damage to the meniscus cartilage and is unable to treat the articular cartilage which will deteriorate anyway if arthritis is present in the knee.

Altcheck conveys that it is not the age of the patient which is the problem but any presence of arthritis that makes the surgery ineffective, “That is what reduces the quality of the outcome. It’s usually the arthritis causing most of the symptoms [of pain].”

The findings from this recent study are encouraging patients to seek out detailed and thorough analysis of what is occurring within their knee and to consider alternative measures than heading straight into surgery.

Weight loss and low impact exercise are accessible measures that are held up as viable options to assist in pain reduction.

Eric Grossman, director of hip and knee replacement surgery at CareMount Medical in New York lands on a helpful understanding of the situation, “”The reasons for overprescribing this surgery are [many] but centre on the fact that surgeons are treating patients that are in pain and are attempting to correct this.”

Indeed good is what is propelling practitioners but he warns, “”If the symptoms are atraumatic in origin and osteoarthritis is present, then surgery is unlikely to be effective and can actually worsen a patient’s condition.”

He continues, “I would encourage patients to ask what the actual success rates are of surgery vs. the alternatives and what option would they choose if they were the patient. And of course, if in doubt, always seek a second opinion.”

While acknowledgement of a patient’s pain and desire to reduce it is understandable and necessary, the calling for effective and data driven responses should be the paramount approach for health care practitioners.

By Amy Henderson – HelloCare Journalist

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