Category Archives: Joints

Surgery no better than placebo in knee pain 

A meta- analysis in the BMJ, shows arthroscopic surgery (partial meniscectomy, debridement, or both) for knee pain in middle-aged and older patients is not any better than placebo (exercise or sham surgery), but can actually cause harm in this population. Adverse effects included clots in the legs, clots in the lungs and death from surgical complications like infection.

The authors conclude, “Available evidence supports the reversal of a common medical practice.”

A New Tool to Find a Surgeon

ProPublica has published a searchable scorecard to help patients choose a surgeon. It includes the complication rates of roughly 17,000 surgeons at 3600 hospitals across the country.

Using Medicare data for inpatient stays from 2009 to 2013, they focused on eight common elective surgeries (e.g., knee or hip replacement, angioplasty, gall bladder removal, prostate removal). They calculated the 30-day readmission rate for surgery-related complications, such as infections, blood clots, uncontrolled bleeding, and misaligned orthopedic devices and adjusted for factors including patient health and age, among other things.

Overall complication rates were 2% to 4%. Roughly 11% of surgeons were responsible for about a quarter of the complications.

The scorecard is searchable by surgeon, hospital, city, and state.

Surgeon Scorecard 


Which Treatment Is Best For Knee Pain

The Annals of Internal Medicine published a meta- analysis comparing the various treatment options available for patients with knee osteoarthritis (OA) suffering from pain. The winner was an injection of hyaluronic acid into the affected knee, followed closely by corticosteroids knee injections. They compared knee injections with oral pain medications like acetaminophen, diclofenac, ibuprofen, naproxen and celebrex. As expected oral acetaminophen, which is not an anti-inflammatory, offered the least benefit.

The analysis included nearly 140 randomized trials involving some 33,000 adults with primary knee OA.

In terms of pain, all active treatments were statistically significantly better than oral placebo, with acetaminophen providing the least benefit and hyaluronic acid providing the greatest.