Saturday, July 15, 2017

What Jane Brody Wishes She Had Known About Her Knees

Check out “What I Wish I’d Known About My Knees” by Jane Brody of the New York Times. It’s a very good article, and you can feel her weary skepticism shining through. Jane Brody has been through a lot trying to get rid of knee pain. For instance, in the 1990s, she wrote a flattering column about the potential of glucosamine. But alas, in the end the supplements didn’t work. She tried a lot of other things that didn’t work too before finally undergoing a double knee replacement.
Many of the procedures people undergo to counter chronic knee pain in the hopes of avoiding a knee replacement have limited or no evidence to support them. Some enrich the pockets of medical practitioners while rarely benefiting patients for more than a few months. 
I wish I had known that before I had succumbed to wishful thinking and tried them all.
She tried arthroscopic surgery for a shredded meniscus. She mentions a systematic review of 12 trials and 13 observational studies that determined that arthroscopic surgery to improve knee arthritis and tears in the meniscus offered no lasting relief or improvement in function.

She also tried hyaluronic acid when she was told her knee arthritis was bone on bone. But, she reports:
The painful, costly injections were said to relieve knee pain in two-thirds of patients. Alas, I was in the third that didn’t benefit.
One of the best parts of the article wasn't even in the article. I fished it out of the comment section. Note the underlined sentences. This commenter, presumably an orthopedic surgeon, is fully aware of the profit motive at work behind all those needless arthroscopic procedures:
I started my orthopedic residency in 1995. We had a monthly journal club where we met at a fairly expensive restaurant (paid for by pharmaceutical or joint replacement companies!) to discuss the articles in the latest orthopedic journals. 
The article that generated the most buzz was a double blind study of patients with meniscal tears. Half the patients got the actual arthroscopic repair, the other half underwent the same general anesthesia and had the same surgical incisions but no actual arthroscopy. Double blind means neither the patients or the surgeons knew which patients were in which group. No difference was seen in the two groups. Some protested that the study was unethical by subjecting the placebo group to the risks of general anesthesia and infection. In retrospect the same could have justifiably been said about those getting the actual procedure. 
Two decades plus, nothing has changed. Arthroscopy is the bread and butter for orthopedic surgeons. A general orthopedist might do a handful of knee replacements in a week while they do twenty scopes. The latter can be scheduled like a factory line, each scope taking less than half an hour to perform. Doesn't pay like a knee replacement but it's far less grueling on the surgeon (and the patient!). Far less likelihood of complications. 
Nothing's changed in 2+ decades, don't hold your breath waiting for the ortho docs to give up their bread and butter!
Something to keep in mind if a surgeon suggests going into your joint to "clean it up a little"!

1 comment:

  1. Thanks for sharing this, Richard. I wish all knee pain sufferers could read it.

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