SPOTLIGHT: Standard medical practice is often pointless.

BIG PICTURE: Each year, a million Americans undergo a procedure in which small cameras are inserted inside their knee. Salt water is injected and bits of cartilage are tidied up in an attempt to relieve pain and swelling.

Called arthroscopy of the knee (or arthroscopic knee surgery), this procedure is described by doctors Prasad and Cifu in their book, Ending Medical Reversal: Improving Outcomes, Saving Lives, as “a wonderful example of a therapy that does not work – despite having been done for years.”

Patients are told their cartilage has degenerated due to normal wear and tear, and that the surgery has a high success rate. They aren’t told about two studies published in 2013.

One found no difference between patients who had surgery versus those who only went to physical therapy (physio). The second study divided patients into two groups. Both went to the operating room where incisions were made and cameras were inserted. Afterward, the patients who’d received the real surgery had no less pain than those whose surgeon had merely pretended to do something.

This surgery is described as minimally invasive, but patients are often given a general anesthetic, which is risky in its own right. They often need crutches and are unable to drive in the short term. Those whose jobs involve strenous labour may be off work for six to eight weeks.

This surgery costs $5,000 per knee and has been described as ‘big business’ and a ‘cash cow’ for surgeons. In 2013, the American Academy of Orthopaedic Surgeons recommended against it for knee pain because, drumroll, there’s no evidence that it works.

TOP TAKEAWAY: The human body is complicated. Our understanding is superficial.

LINKS:

Ending Medical Reversal: Improving Outcomes, Saving Lives Vinayak Prasad and Adam Cifu

• the 2013 physio study
• the 2013 sham surgery study
• Academy of Orthopaedic Surgeons, pages 12-13

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