Orthopedists’ Conflicts of Interest Lead to Overtreatment

When a doctor calls out a whole field of medical specialists for conflicts of interest that risk harming patients, things must really be rotten in the state of orthopedics.

Dr. James Rickert, an Indiana orthopedist, has launched what he calls a “moral persuasion” campaign in the hope of getting his colleagues to stop performing needless surgeries, as reported on MedPageToday.com.

The medical profession in general is vulnerable to financial conflicts of interest, but Rickert, who founded the Society for Patient Centered Orthopedic Surgery, calls orthopedics “one of the worst offenders.”

Following is Rickert’s list of procedures that are frequently performed, are usually unnecessary, cost a lot and sometimes are harmful. If you or a loved one has had one of these surgeries without relief of symptoms, would that qualify you for a medical malpractice suit against the orthopedic surgeon? Not likely, unless you suffered a serious complication that left you worse off than before the surgery. Unfortunately, malpractice lawsuits are too complex, time-consuming and expensive to be worthwhile unless you suffered permanent, life-changing harm.

So be careful before going under the knife for any of Rickert’s questionable “treatments”:

Vertebroplasty

Cost: $10,000
Cement is injected into a fractured vertebra. About 100,000 patients have it every year. It’s falsely marketed as relieving pain quickly, a claim not proved in clinical trials. Risks include compression fractures in adjacent vertebrae, dural tears (tissues covering the spinal cord and nerves), infections, cement migration (the material moves outside of the repair region) and nerve pain requiring subsequent surgery.

Rotator cuff repairs in elderly people

Cost: $15,000
The number of these surgeries increased by 141% between 1996 and 2006; about 600,000 occur every year in the U.S. It’s vastly overused on people with no symptoms. Complications include infection, bleeding, re-rupture of the rotator cuff, nerve damage, blood clots and the need for repeat surgery to correct problems with the first procedure.

Clavicle (collarbone) fracture repair (“plating”) in adolescents
Cost: $13,000
Some adolescents get this treatment to improve athletic function, but Rickert said, “I don’t know of any good indication, especially with conservative care being so successful.”

Regardless of patient age, sports/activity and final clavicle shortening, there’s generally no difference in pain, strength or range of motion. Risks include deep infections, pneumothorax (collapsed lung) and other complications.

Anterior cruciate ligament tear repair in low-risk people
Cost: $10,000
ACL surgeries are performed on about 100,000 patients’ knees every year. Many show no difference in rates of return to pivoting-activity sports one year later when compared with noninvasive rehabilitation and activity modification. Complications include infection, instability, stiffness, pain, patellar (kneecap) fracture and growth plate injury in children (ends of the bones are damaged).

Surgical removal of part of a torn meniscus
Cost: $6,000
About 700,000 patients with knee arthritis and no mechanical symptoms have this procedure every year. It doesn’t result in significant benefit in terms of pain relief or function compared with fake surgery in patients with degenerative meniscal tears.

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