It’s a medical procedure that is performed on an estimated 750,000 people in the U.S. each year. It was performed on nearly 122,000 Medicare recipients in 2016 at a cost of up to $10,000 per patient. And, says a recent study, “it’s also usually a waste, if not downright harmful.”
That quote comes from this article that was just published on the CNBC website, called “The most common knee surgery for seniors is costly, and usually a waste.” It’s the sobering conclusion from a recent study published in the Journal of the American Medical Association Surgery describing a particular type of commonly-prescribed knee surgery called arthroscopic partial meniscectomy, or APM for short. There’s certainly nothing new about arthroscopic surgery to fix an injured knee by repairing the torn meniscus, which is the fibrous cartilage around the joint. For many younger patients the surgery is an effective means of treating acute injury. However, for many older patients, the picture is quite different. “The problem,” reports CNBC, “is that there are two kinds of meniscus tears,” only one of which – “the much less common one – responds to surgery.”
In younger patients, these procedures, accompanied by physical therapy, are typically offered in cases of acute injury, the kind that happens on the basketball court or running to catch a commuter train. These usually afflict people in their 30s, 40s or even 50s. But with older patients, meniscal knee problems are typically the result of wear and tear, not injury, and they are frequently accompanied by osteoarthritis. “Indeed,” says CNBC, “the cartilage that wears out in seniors is a different kind of tissue than what is damaged in acute injuries — the cartilage that bothers older patients is usually articular cartilage, while younger patients injure meniscal cartilage.” The bottom line is that this all-too-common type of knee surgery isn’t effective at repairing degenerative damage and it doesn’t treat the articular cartilage when arthritis is present in the knee. The result, according to the study, is a “giant waste of money [that] could be better spent on other treatments, from something as simple as Advil to more sophisticated courses of physical therapy that will give most patients better results.”
If this type of knee surgery in older patients is so ineffective, why is it over-prescribed to such a degree? The biggest reason may be patient demand – a demand that is not substantiated by the facts. “The reasons for overprescribing this surgery are [many] but center on the fact that surgeons are treating patients that are in pain and are attempting to correct this,” said one surgeon in New York State. Patients are desperate for options and they probably have heard that arthroscopic surgery is a magic bullet, but their expectations are often unrealistic. This same physician calls meniscal repair surgery on older patients “a cautionary tale.” According to the CNBC article, “Main Street doctors say the academic data confirms what they see in their practices and is consistent with other studies showing that doctors too often overprescribe arthroscopic procedures for older patients.”
So if hundreds of millions of dollars in Medicare funds are being wasted annually on surgery that doesn’t work, what’s the answer? The better plan, say medical experts quoted by CNBC, is often a combination of low-impact exercise and weight loss. Avoid exercise such as running that pounds the knee joint with painful pressure, and switch to swimming, biking or other low-impact forms of exercise. Instead of the treadmill, try the elliptical machine or stationary cycle. (One 66-year-old man we know discovered that his knee pain began subsiding when he started doing exercises such as leg lifts to strengthen his thigh muscles, so some gentle weight-bearing exercise might also help.) It may be a challenge to start exercising if you haven’t been doing so, and you’ll need to check with your doctor to make sure, but even small gains in physical activity can help alleviate knee pain. Losing weight is also an obvious way to reduce pressure on the knees, and slimming down gives you the added benefit of improving your overall fitness and often lowering blood pressure. This is one time you can truly gain by losing!
Finally, the CNBC article definitely advises caution about knee surgery when arthritis is present. If the real source of pain is arthritis and not cartilage damage, treatments such as physical therapy, cortisone injections and weight loss are all more effective, less invasive, and far less expensive. Not only that, but if arthritis is present, meniscal knee surgery might actually make things worse. Patients need to be well-informed when they talk with their doctor, and if in doubt, they should always seek a second opinion.
We would add our strongest possible recommendation that one of the most effective ways for you as an older patients to ensure the best, most appropriate medical care is to put yourself in the hands of a geriatric care physician. These men and women are trained to care for senior adults, understanding the unique medical journey each one of us travels as we age. If you’ll contact us at AgingOptions we will refer you to a qualified geriatrician in your area.
In the medical arena there is no substitute for authoritative, trustworthy advice. That also applies in the area of retirement planning, since so much is riding – for you and for those you love – on the decisions you make ahead of time. At AgingOptions we practice a truly all-encompassing form of retirement planning called LifePlanning, an approach in which all the critical elements of retirement life – finances, housing, legal, medical and family – and blended into a seamless strategy to help you enjoy a retirement that is fruitful and secure. As a way of introducing you further to LifePlanning and all its many advantages, we invite you to join Rajiv Nagaich soon at one of our free LifePlanning Seminars, offered at locations throughout the region. Invest just a few hours with Rajiv and we assure you, you’ll never think of retirement the same way again.
You’ll find all the details here, including simple online registration to reserve a seat for you and your guests. Come get the facts about LifePlanning from AgingOptions – you’ll be very glad you did. Age on!
(originally reported at www.cnbc.com)
(Photo source: gwinnettmedical.blogspot.com)