What Percentage is "Useless Orthopedic Surgery" Based on Research?
POSTED ON 9/14/2016 IN Research BY Christopher Centeno
This is a post that some orthopedic surgeons will hate but that needs to be written. This week, I decided to try and estimate the number of orthopedic surgeries that were still being done despite research showing they didn't work. When I was done, I realized that a staggering 53% of orthopedic surgeries being performed are useless (i.e., they have research that shows that they either don't work or are unnecessary).
The Background Most People Don't Know About Orthopedic Surgery
We all believe that our doctor has our best interest at heart, and that's usually the case. However, in the past decade, the research on orthopedic surgery has been brutal—finding that many common surgeries that patients still get every day actually come under the category of useless orthopedic surgery. Don't take my word for it; there's both a recent scientific paper that states this and a recent New York Times article.
To create the above graph, I began with orthopedic procedures that have either been shown to be no better than placebo or conservative care or that have been shown to have no benefit over doing nothing. I then dug into the research to estimate the total number of elective orthopedic procedures and then the annual numbers for each surgery. The above numbers are estimates as some of the data only exists for one recent year or another and some data is years old.
The Useless Orthopedic Surgery List
I will go over these based on the number of surgeries per year. The total number of surgeries per year above has been modified by the number likely to apply to the research. So, for example, for low-back fusion, the goal was only to count the number of fusions done for stenosis.
- Meniscectomy—24%, or approximately 790,000 surgeries annually: No single orthopedic surgery has taken on more fire and been shown to be more ineffective in more clinical situations than meniscectomy. This is where an orthopedic surgeon operates on the meniscus and ends up removing a piece. Many patients believe that the surgeon is fixing or repairing the meniscus, but more than 90% of the time, it's really a meniscectomy surgery. Here's the supporting research:
- Lumbar Discectomy—14%: We've known for a long time, based on the research, that in most patients, surgery to remove a disc herniation is only more effective in the short run and not in the long run. Meaning in the first 6–12 months, most patients with a herniated disc may be better off with surgery, but most won't be all that different at one year later. Based on what we've seen, more than 95% of patients with a herniated disc will never need surgery.
- Knee Replacements—7%: Based on the existing research, about one-third of knee replacements aren't needed. This says nothing of the fact that a recent randomized controlled trial showed that knee replacements weren't all that effective.
- Shoulder Acromioplasty—4%: This is when the surgeon cuts out part of the shoulder-joint complex to open up space for the rotator cuff. Acromioplasty has been shown to be ineffective in multiple studies.
- Lumbar Fusion—2%: This surgery, when used to help patients with stenosis (arthritis that's pressing on nerves), has been shown to be no better than no fusion.
While the above is my best estimate, given the research that's been mounting for the past several years showing how ineffective many orthopedic surgeries truly are when studied, it's not surprising. How much longer will insurers pay for these procedures? Your guess is as good as mine.
The upshot? There are lots of ineffective surgeries out there, and the useless orthopedic surgery list is among the longest as I would estimate that about half of all elective orthopedic surgeries being performed have been shown to be ineffective based on the research. Time for a change?
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