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On the website of the American Academy of Orthopaedic Surgeons (AAOS) is this statement:

To foster conversations between patients and physicians about what care is really necessary, the AAOS recently released a list of five specific tests or procedures that are commonly ordered but not always necessary. The effort is part of the Choosing Wisely® campaign.

Here are the five procedures that AAOS put on its list:

  • We recommend against performing routine postoperative deep vein thrombosis (DVT) ultrasonography screening in patients who undergo elective hip or knee arthroplasty.
  • We recommend against the use of needle lavage to treat patients with symptomatic osteoarthritis (OA) of the knee for long-term relief.
  • We recommend against the use of glucosamine and chondroitin to treat patients with symptomatic OA of the knee.
  • We recommend against the use of lateral heel wedges to treat patients with symptomatic OA of the knee.
  • We recommend against the use of postoperative splinting of the wrist after carpal tunnel release for long-term relief.

You can see that there are no surgical procedures on this list of “not always necessary” offerings from this surgical group.

RickertThat caught the attention of a small group of orthopedic surgeons who call themselves the Society for Patient Centered Orthopedic Surgery. That group, headed by Dr. James Rickert, came up with a quite different list:

  1. Vertebroplasty – defined by Mayo Clinic as “stabilizing compression fractures in the spine. Bone cement is injected into back bones (vertebrae) that have cracked or broken, often because of osteoporosis.”
  2. Rotator cuff repairs in asymptomatic/elderly patients
  3. Operating on simple fractured collarbones in adolescents, inserting metal plates, rather than letting the injury heal using a sling
  4. ACL repair in low-risk individuals
  5. Surgical removal of part of a torn meniscus

Note that all five are surgical procedures.

Dr. Rickert recently joined our editorial team. I interviewed him at the Preventing Overdiagnosis 2015 conference at the National Institutes of Health. He talked about what his group didn’t like about the AAOS list, about conflicts of interest in orthopedics, about health care journalism, and more.

Other resources:

Music used in this podcast:

  • “Sing, Sing, Sing” by Louis Prima
  • “In a Gadda da Vida” by Iron Butterfly
  • “The Greatest Sum” by the Avett Brothers
  • “Future Markets” by Jonny Greenwood
  • “Red Onion” by The Coolin’ System

Thanks to Cristeta Boarini for editing this podcast.


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