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What To Avoid At The Orthopedist's Office

Here's an evidence-based test with no dangerous side effects. But some common orthopedic treatments don't work.
Selim Ucar
Here's an evidence-based test with no dangerous side effects. But some common orthopedic treatments don't work.

If the orthopedist wants to inject saline into your arthritic knee, it's time to say no thanks. Same for taking the popular supplements glucosamine and chondroitin for arthritis pain.

Why? There's no good evidence to prove they'll help you.

Those are two of the latest additions to lists of medical don'ts for doctors and patients.

The reasoning behind the lists is simple. A lot of things that doctors do to patients won't do them any good. Besides being wasteful, some of the tests and treatments may lead to harm.

In a perfect world, data gleaned from clinical trials would get distilled into guidelines about which treatments work best. Doctors would follow the guidelines, making allowance for a person's particular circumstances. Patients would get high-quality, cost-effective care.

But medicine isn't perfect. Even when doctors get paid or punished to change their ways, they often don't.

Research has shown that there are a lot of reasons why doctors don't follow evidence-based guidelines. They include not knowing about the guidelines; disagreeing with them; working at a place that doesn't support change; or just not being motivated to change.

The five not-so-great orthopedic treatments posted today are part of a coalition effort by dozens of medical specialties to change that, called "Choosing Wisely." The procedures to skip, based on guidelines from the American Academy of Orthopaedic Surgeons, are:

  • Routine ultrasound screening to check for deep vein thrombosis in hospital patients after hip and knee replacement surgery, if they don't have symptoms of a blood clot.
  • Needle lavage for knee arthritis pain. Washing out the knee joint with saline doesn't improve pain, stiffness, tenderness, swelling, or walking ability.
  • Glucosamine and chondroitin supplements for arthritis knee pain. There's no evidence that these popular supplements help reduce pain.
  • Lateral wedge insoles for arthritic knees. The idea was that shoe inserts would relieve pressure on worn joint surfaces. But there's little evidence that they help, and people who aren't wearing orthotics may have fewer symptoms.
  • Splinting a wrist after carpal tunnel surgery. Splinting doesn't improve outcome, and can cause increased stiffness and adhesions.
  • The Choosing Wisely program has been cranking for over a year, and the site has collected lists of treatments to avoid from almost two dozen medical specialty societies. It's full of surprises. No antibiotics for pink eye? Who knew?

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    Corrected: September 11, 2013 at 10:00 PM MDT
    The original version of this post said that an orthopedic surgeons' group recommended against ultrasound exams to look for life-threatening blood clots after joint replacement surgery. The recommendation against ultrasound exams is limited only to people in the hospital who have had hip or knee replacement surgery and do not have symptoms of deep vein thrombosis. It does not refer to ultrasound screening in other situations.