As an orthopedic sports medicine surgeon newly in practice, I read with interest Gina Kolata’s article “Why ‘Useless’ Surgery Is Still Popular.” As a doctor with a research background, I often champion the importance of research and promote a practice rooted in evidence-based medicine. It also came to me as no surprise when my partner and several physician assistants in the practice pointed out the article to me. In fact, every few years a similar article on meniscus surgery is published and immediately the nearest sports medicine surgeon is asked his or her opinion.
When it comes to meniscus surgeries, much of what causes the patient pain is still a mystery. There are no major nerve endings in a meniscus, so the mechanism of pain generation is not from the tear itself, but perhaps from the mechanical problems the tear creates in the knee causing the lining to become inflamed. In addition, many people have meniscus tears, especially degenerative tears from years of wear and tear, and have no symptoms.
What many of these studies show is that there is a role of physical therapy in the treatment of meniscus tears, not that surgery is useless. In fact, the studies show surgery is far from useless. In a similar study published in the New England Journal of Medicine entitled “Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis” patients with only a little bit of arthritis were randomized to have surgery for a meniscus tear or undergo physical therapy. Approximately 2/3 of the patients got better in both groups. And those patients that did not improve with physical therapy by 3 or 6 months were able to cross-over into the surgery group and still reap the benefit of surgery: improved pain and function scores.
What this and many other studies show is that patients can get better with either physical therapy (PT) or surgery. However, some patients do not get better with PT and therefore should have surgery with the odds of getting better in their favor. Furthermore, the research shows that patients who undergo surgery get better faster. This becomes important when some patients present with such pain they cannot do PT or they do not have the time or are unwilling to wait months for improvement. Thus, if a patient wishes to avoid the risks of surgery and is willing to wait for similar results, he or she should undergo physical therapy and if it works, great! If not, they can then undergo surgery whose results are far from “useless”.
What all of this boils down to is presenting patients with appropriate information so they can make an informed decision with their surgeon. Medicine is not a “cookie-cutter” practice and to misinterpret data simply to sensationalize surgery as harmful or useless is irresponsible and often, incorrect. I encourage journalists, patients, and doctors to ensure that medical information that is released into the press is adequately vetted to eliminate bias. The urge to create controversy that undermines the balance between science and the art of medical practice may actually be harmful to the patient if it disrupts the patient-physician relationship and arms the patient with misinformation. I agree that ineffective surgeries should not be performed. Unfortunately, people tend to have a reductionist mentality and want to see things as good or bad. Research data can tell us that, but all too often the data tells us something in between.
Jonathan D. Gelber is an orthopedic surgeon. This article originally appeared in the Huffington Post.
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