In essence, meniscal tears (or “wear” as we call it now) seem

Think Twice Before Getting Knee Surgery

During the 4,000 year history of medicine, doctors have done terrible things to patients. We gave them arsenic and mercury; we bled them; we made them vomit, and we gave them laxatives; we made them hot, and we made them cold. A lot of this was nonsense, sometimes dangerous and even deadly. You would expect that eventually patients would catch on and learn to avoid doctors, but most didn’t. Many got better buy moncler jackets despite the dreadful treatments and felt only gratitude.

cheap moncler jackets sale The magic of medical success has always been, and, to a large extent, still is, the remarkable power of the placebo effect: getting better due to a tincture of time and the magical power of hopeful expectations. Many popular treatments are popular more because of placebo effect than because of any physiologic changes. Placebo is the best medicine ever invented. cheap moncler jackets sale

cheap moncler jackets The placebo effect is endlessly fascinating. We know that two pills produce a greater placebo effect than one, that brand name pills work better than their generic equivalents, that expensive pills are more powerful, and moncler mens jackets that placebos work even when patients know they are placebos. And placebo injections work even better than placebo pills. cheap moncler jackets

moncler sale outlet The study of the placebo effect in surgery has lagged far behind the study of its role in medicine, because doing placebo surgery is harder than giving a placebo pill. Yet there is every reason to believe that surgery is especially prone to placebo effects. The more dramatic the procedure, the more likely it raises hope of cure. “Quick, operate before the patient gets better” is one of those jokes that moncler outlet online orthopedic surgeons tell among themselves, barely covering a hard truth: that a lot of elective surgery might be unnecessary or even harmful. moncler sale outlet

moncler sale Dr. Teppo Jarvinen is the orthopedic moncler sale outlet surgeon best qualified to explain this issue. As the Jane and Aatos Erkko Foundation Clinical Professor of Orthopedics and Traumatology at the University of Helsinki, he was the principal investigator in the most rigorous study of placebo controlled knee surgery. Dr. Jarvinen writes: moncler sale

Accumulating evidence now proves that much of arthroscopic (keyhole) knee surgery may be unnecessary because the results are no better than placebo.

moncler outlet This is an Moncler Outlet especially startling finding because this is the second most common surgical cheap moncler procedure in the world (after cataract surgery). moncler outlet

Every year, about 1 million people undergo this procedure in the US alone. And for most, there is likely no benefit compared to doing nothing.

moncler outlet jackets The surgery is done so often because it has a perfect biological rationale and intuitively makes perfect sense. There is a lesion moncler outlet store (“damaged meniscus”) that can actually be easily identified through the keyhole surgery. The therapeutic procedure trimming the ragged edges off a torn meniscus and smoothing the edges of what remains takes no more than 15 minutes. moncler outlet jackets

So, picture yourself as an orthopedic surgeon. How great to feel that you are doing something exceptionally useful for your patients. Surgeons become surgeons because they love to “separate the patient from the disease” with nifty procedures?

moncler outlet sale And the knee surgery cheap moncler outlet patients generally do get better and feel grateful 90% report being satisfied after the surgery. They believe that the surgery has fixed their knee problem. moncler outlet sale

And to cap it all, insurance companies pay well for the procedure.

There cheap moncler coats is only one fly in the ointment in this “almost too good to be true” story it is too good to be true. There is little proof that this kind of keyhole surgery for knee pain actually works.

moncler outlet online The only previous placebo controlled study in patients with advanced knee osteoarthritis found that actual surgery was no better than sham surgery (skin incisions only). Published 10 years ago, this report marked an important turning point for the orthopedic community provoking unprecedented criticism and even hostility. Not surprising since it was such a blow to professional pride and a potential threat to a very common and lucrative orthopaedic procedure. moncler outlet online

My team decided to repeat the study, but with patients who had only a torn meniscus, the crescent shaped cartilage that helps cushion and stabilize knees. Patients with a torn meniscus seemed more likely to respond to surgery because they didn’t have all the nonspecific damage associated with advanced osteoarthritis.

We inserted an arthroscope through small “keyholes” moncler sale in the skin, which allowed us to see inside the knee. Through this hole we inserted tools that could trim the torn meniscus and smooth ragged edges of what remained.

The 146 volunteer patients all received anesthesia and incisions. Half received actual surgery; the other half got the sham procedure, which was just taking a peek inside the knee, but no trimming. The patients didn’t know which procedure they got real surgery or sham surgery.

Both groups had equivalent results. A year later, approximately 80% of patients in both groups said their knees felt better, and over 90% said they would choose the same method again, even the patients who fake surgery.

moncler outlet store After the publication of our study, we have been asked many times whether our findings were completely surprising or unexpected? moncler outlet store

moncler outlet uk Actually there is no reason to be surprised. A few years ago, a Harvard group published a pivotal study which showed that meniscal tears are very common in all middle aged people, irrespective of whether or not they have knee pain. In essence, meniscal tears (or “wear” as we call it now) seem to be a very normal finding in an MRI scan. moncler outlet uk

cheap moncler outlet In 1998, a US surgeon had his orthopedic brother carry out keyhole surgery to his own knee under local anesthesia. He asked his brother to “poke around” within the knee and showed that meniscus is completely insensitive to pain. Although commonly ignored by most orthopedic peers, his eperience makes one wonder how such a dull tissue could be the origin to knee pain. cheap moncler outlet

moncler factory outlet Now you’re probably wondering, who exactly needs knee surgery? Frankly, that’s still a complicated question, but let me simplify it by saying that without a true traumatic event (for example, really twisting your knee) resulting in your knee filling up with blood (truly swollen knee). If you are able to move your knee freely (even with some possible pain), there is no urgent need to have your knee “scoped.” Rather, go and see your physiotherapist, start a good rehab program and give it some 3 4 months to let nature take its course. If you still have persistent pain, you may then consider consulting an orthopedic surgeon. moncler factory outlet

moncler jacket sale I heard a beautiful analogy that hopefully helps middle aged people like me adjust to painful knees degenerative meniscus tears are like the wrinkles that come with aging and should be treated accordingly. moncler jacket sale

moncler jackets outlet Great advice from Dr. Jarvinen. His is one of those landmark studies that should change the world. Patients, beware before accepting the moncler outlet knife. Insurance companies, take note in establishing standards for reimbursement. Guideline makers, insert watchful waiting and rehab before recommending surgery. And surgeons, adjust your practice. moncler jackets outlet

cheap moncler coats Everyone talks about evidence based medicine, but often there is a long time lag before compelling evidence actually affects clinical practice. This is bad for the patient, bad for the healthcare system, and bad for society. We shouldn’t continue doing cheap moncler sale senseless, expensive, and potentially harmful procedures moncler outlet sale just because they produce a strong placebo effect. cheap moncler coats

My knees are aching a bit as I write this and certainly make themselves known every time I climb cheap moncler jackets up a flight of stairs. None of my body parts works as well as they once did. And my mind seems increasingly to be out to lunch. Aging will do that to you. There is not a medical or surgical solution to the wear and tear of life. If you have bum knees, think exercise and weight loss before submitting to the knife.