Posted On: December 8, 2013 by Patrick A. Malone

Orthopedic Treatments You Should Reject

Sometimes, routine is not in a patient’s best interest. As described in a story on NPR, doctors accustomed to prescribing certain treatments for bones and joints don’t always revise their practices when scientific evidence calls for doing things differently from how they used to.

In terms of orthopedists — doctors who specialize in the musculoskeletal system — some routines are no longer considered best practice.

“Even when doctors get paid or punished to change their ways, they often don't,” according to NPR.

“Research has shown that there are a lot of reasons why doctors don't follow evidence-based guidelines. They include not knowing about the guidelines; disagreeing with them; working at a place that doesn't support change; or just not being motivated to change.”

But that doesn’t mean that patients can’t assume some measure of control when their doctors advise treatment that is wasteful, won’t do them any good and/or has the potential to do harm.

Following are five common orthopedic treatments you should seriously question if not outright reject despite your doctor’s recommendation.

According to the American Academy of Orthopaedic Surgeons, you should reject:


  • routine ultrasound screening to check for deep vein thrombosis in the hospital after a hip or knee replacement surgery, if you don't have symptoms of a blood clot.

  • needle lavage (saline injections) for knee arthritis pain. Washing out the knee joint with saline doesn't improve pain, stiffness, tenderness, swelling or walking ability.

  • glucosamine and chondroitin supplements for arthritis knee pain. There's no evidence that these popular supplements help reduce pain.

  • lateral wedge insoles for arthritic knees. Shoe inserts were thought to relieve pressure on worn joint surfaces, but there's little evidence that they help, and if you don’t wear orthotics you might have fewer symptoms.

  • splinting your wrist after carpal tunnel surgery. Splinting doesn't improve outcomes, and can cause increased stiffness and adhesions.


The list is part of a series from Choosing Wisely, an initiative of the American Board of Internal Medicine (ABIM) Foundation. Its mission is to encourage physicians, patients and other health-care stakeholders to think and talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm.

We’ve written about other advisories Choosing Wisely has issued here and here.

To see the full inventory, see Choosing Wisely’s page of lists. They were devised by U.S. medical specialty organizations representing more than 500,000 physicians who recognize the importance of doctor-patient conversations to improve care and eliminate unnecessary tests and procedures.

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