Orthopedists Name Needless Kinds of Care

American Academy of Orthopedic Surgeons issues list of unnecessary treatments

(RxWiki News) Knowing which medical treatments are needed and which aren't plays an important role in personal wellness and in creating an efficient healthcare system. Now, individuals with arthritis and other difficulties getting around have a shortlist of procedures many of them can do without.

More than one in four people in the United States have arthritis, broken bones and other musculoskeletal conditions that demand medical care, according to the American Academy of Orthopaedic Surgeons (AAOS), which has released its list of five avoidable procedures or treatments.

Among the care people with those conditions can avoid are certain ultrasound screenings, wrist splints and shoe insoles.

"Talk to your doctor about which medical procedures are unnecessary."

"The most commonly used diagnostic or therapeutic intervention on the list is the use of glucosamine-chondroitin sulfate for management of symptomatic osteoarthritis of the knee, which currently represents [an] $800 million annual market in the US alone," said Kevin Bozic, MD, chairman of the AAOS' Council on Research and Quality.

"It is important for patients to be full partners in health care decisions, and providing this information empowers patients. Educating patients about ineffective treatments can help to reduce the demand and allow the focus to be on evidence-based options to improve their quality of life," Dr. Bozic said.

These are five procedures that AAOS recommends avoiding:

  • Routine, post-surgical ultrasound to check for the presence of deep vein blood clots in patients who elected to have a hip or knee replaced with artificial medical devices.
  • Injecting osteoarthritic knees with sterile saline solution — known as needle lavage — as a potential form of long-term relief.
  • Glucosamine and chondroitin supplements for patients with osteoarthritis of the knee.
  • Lateral wedge insoles for those with medial compartment osteoarthritis of the knee.
  • Post-surgical wrist splints to relieve the pain and discomfort associated with carpal tunnel syndrome.

Those are the kinds of common but sometimes needless procedures about which patients and doctors should have a deeper conversation before assuming they're needed, according to AAOS.

Volunteers physicians and paid staff from AAOS developed what they say are evidence-based guidelines for treatment, including ones that have been published by the Journal of Bone and Joint Surgery.

"As orthopedic surgeons, our duty to our patients is to restore mobility and improve their quality of life through evidence-based, high-quality treatment," said Joshua J. Jacobs, MD, president of the 37,000-member organization. "Identifying tests, procedures or treatments that show little to no value not only helps our patients by preventing unnecessary care, but will end up saving health care dollars."

The orthopedists group released its recommendations as part of its membership in the American Board of Internal Medicine (ABIM) Foundation's Choosing Wisely campaign, which launched in December 2011.

Thus far, ABIM's partners include 25 medical organizations that support Choosing Wisely's goal of having patients and doctors reduce overuse of procedures that medical studies, among other evidence, suggest are not necessarily beneficial, ABIM said. Those goals also aim to ensure an optimum of patient care.

"The content of this list and all of the others developed through this effort are helping physicians and patients across the country engage in conversations about what care they need, and what we can do to reduce waste and overuse in our health care system," Richard J. Baron, MD, ABIM Foundation Chief Executive Officer and President, said in a press statement.

"The best approach to screen for life-threatening blood clots in the legs is to know and look for the warning signs.  The warning signs of blood clots can include pain in the calf and leg (unrelated to your incision), tenderness or redness about or below the knee, and swelling of your thigh, calf, ankle, or foot.  The warning signs of pulmonary embolism can include sudden shortness of breath and chest pain (particularly with breathing)," Andrew Cash, MD, a spine surgeon at Desert Institute of Spine Care, told dailyRx News.

"It is important to follow your doctor's instructions carefully to minimize the risk for blood clots during the first several weeks of recovery from surgery," said Dr. Cash.

To date, Choosing Wisely has pinpointed 250 tests and procedures that it deems as overused.

Non-medical organizations participating in Choosing Wisely range from the American Association of Retired Persons to Consumer Reports Foundation and the National Business Coalition on Health.

The list was published online September 11 by the American Academy of Orthopaedic Surgeons and Choosing Wisely.

Review Date: 
September 11, 2013