Hold tight to that injured knee: The most common, expensive surgery is proven "useless" / by sylvia kronstadt

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Registered: 03-14-2011
Hold tight to that injured knee: The most common, expensive surgery is proven "useless" / by sylvia kronstadt
Tue, 01-07-2014 - 10:09am

Festive New Year's wish for my orthopedic surgeon: A knee to the groin

WHAT A FEELING! Being cut open for your doctor's fun and profit!


     Months after I had expensive and ineffective knee surgery a year ago, I just happened to come across several old and new studies that concluded the procedure is "useless." Naturally, I was pissed.
    Now, the most credible clinical trial to date has determined that meniscus surgery -- the most common orthopedic procedure in the U.S., performed about 700,000 times a year at an estimated cost of $4 billion -- works no better than totally "fake" operations. Thanks a lot, Dr. Lancome, you fancy-pants impostor!

Get him good, brother!

    If Dr. Lancome had never heard of these studies, it would have constituted professional negligence. If he had, he was guilty -- as far as I'm concerned -- of fraud and assault.
    I had rehabbed my own knee very well before the surgery, but by December 2012, I had reached a plateau. I was pain-free most of the time, but the inflammation surfaced often enough that I was afraid it would forever be vulnerable to re-injury. 

    My jogging and power walking mean everything to me. I was determined to do whatever was necessary to ensure that I could continue my exercise regimen, which I have sustained for 35 years.

    I had never heard of the meniscus. It is the cartilage formation inside your knee, behind the kneecap and between your thigh and shin bones (the fibula and tibia, for those who remember 8th-grade physiology). If it gets torn when you're young, it can sometimes be repaired. Once you're older, the best they can do is cut out the damaged part and "clean things up in there," which was Dr. Lancome's plan.

It's really quite cute. How could I not have known it was there?

It serves as a durable, reliable cushion.

  Studies dating back to the '80s, and which my doctor must surely have known about, indicate that meniscus surgery is no more effective than physical therapy in restoring functionality and relieving pain. I can't believe I didn't do my homework on this.  Once the surgeon said "you need surgery," (surprise, surprise), everything proceeded quickly, and I didn't say, "Hold your horses and put down your scalpels. I want to look into the pros and cons of this myself." 
    That's what I usually do. He was just so majesterially authoritative that I let him sweep me away and propel me into his "theater." Damn!

THE UNKINDEST CUT OF ALL

    A few months after my surgery, a March 2013 article by Jeffrey N. Katz et al in the New England Journal of Medicine (http://www.nejm.org/doi/full/10.1056/NEJMoa1301408) corroborated the 1980s  studies, reporting  that there were no significant differences in outcome between patients assigned to arthroscopic partial meniscectomy (which is what I had) plus postoperative physical therapy, and patients assigned to a standardized physical-therapy regimen. After six months, and after 12 months, their levels of satisfaction were equivalent. Another study indicated that these results held up after five years.

CAN'T GET NO SATISFACTION 

    There was a subset who just did physical therapy, and weren't satisfied with the results. When they went on to have the surgery, their satisfaction did not improve.

It's horribly boring, but you can handle it yourself.

     To make matters worse, among those who do have the surgery, there are several possible complications, including an increased risk for needing  a complete knee replacement and an exacerbation of osteoarthritis.  
    In fact, I have had a significant exacerbation of osteoarthritis that I am addressing on my own terms -- which is what I should have done all along. I almost always regret it when I involve doctors in my health care. Let's just learn to take care of ourselves -- the resources are readily available (http://kronstantinople.blogspot.com/2013/03/doctor-who-doctor-you.html).
    In the most recent and most rigorously designed study, surgery worked no better than fake operations for those with tears in the meniscus, suggesting that thousands of people may be undergoing unnecessary surgery, according to The New England Journal of Medicine. (http://www.nejm.org/doi/full/10.1056/NEJMoa1305189).

CHAMPAGNE FOR MY REAL FRIENDS, REAL PAIN FOR MY SHAM FRIENDS

    The volunteer patients in the study all received anesthesia and incisions, according to study authors. But some received actual surgery, others simulated procedures. They did not know which.

    A year later, most patients in both groups said their knees felt better, and the vast majority said they would choose the same method again, even if it was fake.
"It's a very elegant, noninvasive procedure" -- if you're conked out.
So interesting, so inspiring -- and so pointless.       "There’s a lot of pressure to operate," Dr. Kenneth Fine admitted to the New York Times. "Financial, obviously. But also, if a primary care doctor keeps sending me patients who are complaining of knee pain and I keep not operating on them, then the primary care doctor is going to stop sending me patients." (http://www.nytimes.com/2013/12/26/health/common-knee-surgery-does-very-little-for-some-study-suggests.html)

   What a stupid, STUPID rationale for cutting people open! Was he sober when he said this to a reporter?  

HIPPOCRATES IN TEARS
    First do no harm. Subjecting my brain to general anesthesia is harm. Puncturing my skin and jamming instruments into me is harm. Giving me 40 opiate pain-killers is harm, especially since I revealed on my intake form that I have had problems with alcohol and drug dependency (thanks for the party though....Those Lortab are delicious) (I never use them for pain. I use them for FUN.) Owning a major stake in the outpatient surgical center is harm -- to your ethics and objectivity. Scheduling your patients for weeks of rehab at a physical therapy center that you OWN is harm, also to your ethics and objectivity. Do you own the Lortab manufacturing plant as well, Dr. Lancome? Have you placed your order for that new Escalade?

For those days when you want to project your brash, domineering side.

    Or are you feeling too sexy in the Lamborghini? You do look pretty good in it.

Thanks for the ride, you Master of the Universe!
It's still cute, even though it's "so last year."

    My knee still gives me quite a bit of trouble, but I work around it. I'm glad I'm running my own show again, and by running, I mean five miles a day, seven days a week.
    My whole experience with Lancome (I called him "Dr. Dreamy") was very colorful and entertaining (http://kronstantinople.blogspot.com/2013/01/happy-2013-to-me-dr-dreamy-does-bedroom.html). At least someone arranged for my adopted, "Save the Children" son, the adorable pop star Bruno Mars, to visit me just as the surgery was ending (oh great: I'm in stirrups and a shower cap). Despite that, I would rather have spent my $7,000 surgical fee on some other kind of entertainment.

A little token of my affection.

  Don't you think I should send Bruno a gratuity for his gracious bedside appearance? My boy hugged me -- at last!
    I would like to give Dr. Lancome a knee. For free.