Knee-pain surgery, performed 400,000 times a year, deemed ‘useless’

Surgeons’ propensity to perform a common procedure may transfer patients’ knee discomfort to their wallets.

The New York Times, in its Upshot column, pulls together a growing body of research that indicates that surgeries for meniscus tears are “useless.” The arthroscopic procedure, however, is popular with the middle-aged and older when afflicted with knee pain, and some 400,000 Americans annually go under the knife for tears to their menisci, two C-shaped pieces of cartilage that act like a cushion between the shinbone and thighbone.

Although patients complain that meniscus injuries leave them stiff, with pain, and a joint that clicks or catches, researchers in Boston looked closer and found that many people have similar tears with no issue; they also considered that many patients failed to improve after surgery. When they weighed the results of surgery versus physical therapy, the researchers concluded that the operation produced no better results.

This affirmed the findings of a published 2015 meta analysis of meniscus procedures, and a British study reported similar results in July. That latest research, published in the peer-reviewed, highly regarded British Medical Journal, was accompanied by an editorial, which The Times says, “came to a scathing conclusion: The surgery is ‘a highly questionable practice without supporting evidence of even moderate quality,’ adding, ‘Good evidence has been widely ignored.’ “

Gina Kolata, a seasoned health and medical journalist for the Times, writes in her Upshot column that the meniscus surgery is one of many procedures that evidence-based research has cast major doubt on−yet doctors keep performing. She recalls that researchers found no data to support the use of spinal fusions, in comparison with other less invasive and cheaper approaches, to alleviate back pain; surgeons still perform these, though insurers may be ending them by declining to pay.

Similarly, patients are told they need vertebroplasty or kyphoplasty, two similar back procedures injecting cement-like substances or introducing balloons between spinal vertebrae. Proponents say this stabilizes these key back components and reduces pain. But research, published in the peer-reviewed, prestigious New England Journal of Medicine, again, found little benefit for these procedures versus a sham surgery.

Let’s be clear about surgery versus other approaches to helping patients with knee and back woes: All operations have risks; they can create great discomfort and significant harms, as I see, sadly, all too often in my practice. These procedures aren’t cheap. Surgical meniscus repair costs roughly $5,000, versus physical therapy for $1,000. Kyphoplasty, by the way, can cost between $9,000 and $19,000, while vertebroplasty goes for $2,300 to $5,800; the federal government has gone after hospitals for Medicare over-charges for both these procedures. Spinal fusions can cost between $100,000 to $169,000. I’ve written before on how debilitating back pain can be, and how alternative therapies should be considered. I also noted two years ago the dubious nature of meniscus surgeries.

C’mon, docs, give it up. This helps neither your reputation nor your reputation. Patients will get wise to this kind of expensive, unnecessary care, especially if they do some homework and find the excellent work of researchers who bolster evidence-based treatments rather than expensive hokum; kudos to these experts. When patients do suffer harm as a result of procedures with known, poor or minimal outcomes, here’s hoping that lawsuits in the civil justice system send powerful, stinging rebukes in the form of sizable judgements against surgeons who push their profits with nonsense operations.