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Posted July 20, 2013: by Bill Sardi
Maybe upstate New York surgeon Spyros Panos was a bit more obvious than his colleagues. Dr. Spyros never even pretended to use surgical instruments after he surgically opened knees, briefly inserted and withdrew a scope, then sewed up a small wound and billed insurance. Dr. Spyros is accused of booking more than 22 surgical procedures in a single day and delivering needless care.
But isn’t that precisely what all orthopedic surgeons do?
Over a decade ago a landmark report published in The New England Journal of Medicine compared levels of pain relief among patients who either underwent an operation that cleaned out (debride) dead tissue from the knee or a simulated operation where an incision was made but no scope was inserted. There was no difference in pain noted between the group undergoing the clean-up operation and the sham surgery.
Yet another troubling report was published in the same issue of The New England Journal of Medicine that confirmed many patients do in fact have small cartilage tears in their knees, but these tears are not the source of their pain.
Six years later another similar study was performed and published in the same medical journal. That study showed that debridement surgery resulted in no better range of pain-free motion than physical or medical therapy.
A news report published in The Washington Post in 2008 said the earlier 2002- studies were simply disregarded by orthopedic surgeons and the parade of needless knee operations continued. That news report quoted a surgeon as saying about a third of the knee operations being performed in the US are for osteoarthritis (wear-and-tear arthritis), a condition that cannot be remedied by surgery.
Not only is knee surgery under scrutiny, but the imaging that is performed to aid in diagnosis. A study published in 2006 found MIR (magnetic resonance imaging) produced false positive diagnoses 42-65% of the time with 37% of the knee operations judged to be needless.
Knee surgery is sounding more and more like a racket rather than medical therapy.
So the patient feels the pain, sees the medical image that confirms there is a cartilage tear and is easy prey to give consent for surgery.
But the volume of knee operations has not declined. Between 1996 and 2006 the number of knee operations increased 49%. Orthopedic surgeons did perform fewer arthroscopic knee operations over that time period, but made up for it by treating more “knee injuries.” In 2006 almost 1 million arthroscopic knee operations were performed, half of them for the tears in the meniscus (cartilage).
A news report says Medicare stopped paying for arthroscopic knee surgery for arthritis back in 2003 and the number of these operations declined by 77%. But it appears the surgeons simply coded these operations differently and continued to cut, scrape and sew.
The one thing bone doctors do perform that properly addresses the cause of knee arthritis is replacement injection of a lubricating viscous fluid called hyaluronic acid into the joint space. This is reported to produce improvement in pain or function in about half of the treated cases. Continued injection of hyaluronic acid into the joint space is reported to delay knee joint replacement surgery by 2.67 years. Injection of hyaluronic acid is considered to be superior to injection of water (placebo) and surpasses the pain relief provided by over-the-counter medications. Five weekly hyaluronic acid injections for four weeks produce a carry-over effect for 1 year. (At $1000 per injection, that regimen would cost ~$20,000.)
However, a broader review of the data concludes hyaluronic acid injections may only be mildly helpful for patients with a modest degree of pain and narrowing of their joint space.
Of interest, doctors in Turkey applied heated mud packs (consisting of humic acid, bitumen, minerals, cellulose, water, pectin, hydrogen sulfide and iodine) for 30 minutes daily for 12 week days. Six months later mud-pack therapy compared favorably to the results achieved by injection of hyaluronic acid.
An overlooked discovery is that injection of hyaluronic acid into the knee joint space has been found to generate more hyaluronic acid than what was originally injected. Investigators believe injected hyaluronic acid stimulates fibroblast cells to produce more regenerative joint lubrication.
What goes ignored is that oral hyaluronic acid appears to work superiorly to injected hyaluronic acid at obvious cost savings and avoidance of side effects associated with needle injection. American orthopedic doctors claim, without substantiation, that oral hyaluronic acid is too large a molecule to be absorbed. But stomach acid breaks down HA so that small but significant amounts are absorbed orally.
This author wrote a book about oral hyaluronic acid over ten years ago and has received frequent reports of prolonged pain relief and cancelled knee operations. Investigators in Japan confirm that oral HA is effective for osteoarthritis of the knee. Other investigators in the U.S. also confirm oral HA is effective.
Mud pack therapy, cited above, likely stimulates fibroblasts to make more hyaluronic acid via external disturbance.
Orthopedists, like other medical specialists, continue to ignore more economical and less costly dietary supplements because they aren’t connected with an insurance billing code and do not generate income comparable with existing invasive treatments. Dietary supplements are on an uneven playing field, being misclassified as “unproven,” but if they are proven, they are declared a drug. By their very definition, dietary supplements can never be given a chance to be “proven.” – ©2013 Bill Sardi, Knowledge of Health, Inc.
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