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October 26, 2021

October 26, 2021

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Unnecessary Joint Replacement Surgery Creates Thriving Industry

by | Sep 28, 2021 |

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“The sales tail has always wagged the dog in medicine. Meaning sales targets for drugs and devices and aggressive sales reps have always determined more about what care is offered to patients than actual medical need. One of the biggest areas of abuse has always been in orthopedics,” explains Chris Centano, MD.

Dr. Centano went on to say that joint replacements may be the biggest offender where a number of companies even have sales reps in operating rooms. Knee replacements have more than doubled in the past 15 years and are now being marketed to younger and younger patients.

The senior author of this article has had an artificial knee for over a decade. It was installed as emergency surgery from a play at the plate in a baseball game in which he was the catcher. He says he could not swear in court that he actually has it as it has never felt different than a perfect natural knee. So, it should be clear we are all for the wonderful medical development of artificial joints. 

Yet our research has shown that it is likely that as many as a third of knee joint replacements were unnecessary or even ill-advised. This fraction would likely not include any of the 44 percent of retired professional football players that a Washington Post report said would eventually require replacement surgery. Regardless of this statistic, the pressure marketing of device manufacturers to orthopedic surgeons and the fact that many people would have been better off with a loss of weight to take pressure off the knee joint leads us to be skeptical of many replacement surgeries.

Medical industry payments to orthopedic surgeons have risen sharply in recent years according to an investigation by Kaiser Health News (KHN). These payments come in various forms from royalties for helping design devices, much more for promoting the devices, speaking about them at conferences and consulting work which often cannot be supported, and a variety of other perks.

Health investigators have focused far more on collusion in the pharmaceutical industry than in the orthopedic area. Unwarranted drugs can easily be discontinued but a device implanted in a body is surely another matter. KHN estimated that between 2013 and 2019 over 3 billion dollars changed hands among manufacturers and orthopedic surgeons.

Device makers say the long-established practice leads to higher quality, safer products. Scott Whitaker, CEO of AdvaMed, the industry’s trade group, strongly supported this position in an interview with Epoch Times in July 2021. Others say that all that money changing hands can corrupt medical judgment and tempt surgeons to perform unnecessary surgeries.

Taxpayers shoulder much of the costs through Medicare for those over 65 and Medicaid for low-income citizens. The demand for surgeries has mushroomed among older folks seeking relief from joint pain and restricted movement. Over 250 manufacturers compete for a piece of the pie.

Congress now requires device makers to report payments to surgeons to a government-run website called Open Payments. Records show that more than 600,000 doctors of all kinds receive some payments from the medical industry and several orthopedists received millions in 2019. Over 80 percent of them, however, received less than $5,000. 

Most orthopedic surgeons tell us that a great many patients are overweight but unwilling to lose weight to reduce knee discomfort, even though it is obvious that this would improve their situation. In July 2018 a study from England in the European Journal of Orthopedic Surgery and Traumatology found surgeons at odds with each other over whether patients should have surgery and then lose weight or the reverse. In our minds, it is more obvious to lose weight first possibly helping pain to decline to eliminate the need for surgery. But surprisingly the surgeons were split nearly 50/50 on the question.

The same study did show that, on reducing weight, an improvement in pain reduction was experienced among 72% of patients and none in the remaining 28%. The fact that, after losing 10 pounds, the 68-year-old junior author of this article is now able to run practically pain-free after years of serious knee troubles certainly supports this conclusion.  As shown in the following graph from the CDC website (see “Prevalence of Overweight, Obesity, and Severe Obesity Among Adults Aged 20 and Over: United States, 1960–1962 Through 2017–2018”), the rate of obesity has been rising rapidly in the U.S. since 1980. No wonder so many people are experiencing pain in load-bearing joints. For many, the solution is simple – lose weight and get healthy; don’t rush to surgery!

 

Our experience over the years with knee replacements finds that beneficial results decline with age which again would seem obvious.

A number of well-constructed medical studies have shown significant improvements in aging degeneration that result from weight loss. A research team lead by Tufts University and Temple University Schools of Medicine found that weight loss could reduce inflammation in older patients suffering from degenerative knee problems. The study published in BioMed Central said simply that older and overweight individuals may be more susceptible to osteoarthritis because being older and overweight alters tissue turnover in the knee’s meniscus, articulate cartilage, and bone via altered glucose homeostasis (blood sugar regulation) and inflammation. If you manage the inflammation, you can manage knee pain and help repair degenerative knee disease.

The senior author of this article experienced precisely this result after being advised that surgery was recommended for his other knee. Within months the problem disappeared. Physical therapy was the most major part of the effective prescription. Our goal in this article is to raise questions among our readers when presented with the problems addressed here.

Dr. Jane Orient will be our guest on The Other Side of the Story this Saturday, Oct 2nd, and Sunday, Oct 3rd at 11 AM ET, with an encore at 8 PM. Listen on iHeart Radio, our world-class media player, or our free apps on AppleAndroid, or Alexa. Each episode goes to major podcast networks early in the week and can be heard on-demand anywhere in the world.

Dr. Orient will discuss these and other related medical biases that may be interfering with America’s best health care. We will ask Dr. Orient a variety of questions including:

1- are prescription drugs overused?
2 – is pushing everyone to get a COVID injection overkill?
3- are controls on pain medications interfering with the needs of patients?
4- are pharmaceutical companies obtaining too much control in the application of patient treatment?
5- has the level of excellence at the Centers for Disease Control declined and if so, why?
6- how have third-party medical payments affected the costs and efficacy of medical treatment?
7- how has socialized medicine worked in other countries?
8- is the main problem the cost of advanced equipment technology?
9- how would you compare today’s management of our health by the medical profession to what it was in your youth?
10- while there is enough blame to go around for our problems what three things would you do were you the nation’s chief doctor?

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Dr. Jay Lehr is a Senior Policy Analyst with the International Climate Science Coalition and former Science Director of The Heartland Institute. He is an internationally renowned scientist, author, and speaker who has testified before Congress on dozens of occasions on environmental issues and consulted with nearly every agency of the national government and many foreign countries. After graduating from Princeton University at the age of 20 with a degree in Geological Engineering, he received the nation’s first Ph.D. in Groundwater Hydrology from the University of Arizona. He later became executive director of the National Association of Groundwater Scientists and Engineers.

Tom Harris is Executive Director of the Ottawa, Canada-based International Climate Science Coalition, and a policy advisor to The Heartland Institute. He has 40 years experience as a mechanical engineer/project manager, science and technology communications professional, technical trainer, and S&T advisor to a former Opposition Senior Environment Critic in Canada’s Parliament.

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