This news story uses a recent meta-analysis of already-published research as the news hook to review the pros and cons of arthroscopic knee surgery to treat both acute and chronic knee pain.
The article overall leaves thoughtful readers with a “think twice or thrice” take home message if they are considering arthroscopy, or told by a physician to have it.
The story could have done a better job discussing the evidence for and against this common surgery. It also mostly misses emphasizing a key point in the published research that for the vast majority of patients who undergo arthroscopy when they have both degenerative disease and tears in the knee’s cushioning tissue, exercise works just as well.
Given the rare but potentially serious risks of arthroscopy (infection and blood clots, for example, as noted in the article) and the lengthy recovery and rehab (around six weeks of limitation and therapy), stories like this one are important to help the public understand the serious limitations of arthroscopy, and to avoid the lure of a promised but unlikely quick surgical “fix” for pain. That lure is substantial, given that what often works better over time is serious weight loss, exercise and other lifestyle changes that most people find difficult at best.
Although the article puts an overall price tag on arthroscopy nationwide, the reader will not learn what a typical arthroscopy costs, whether most or all are covered by insurance (including Medicaid and Medicare) and the comparative costs of cortisone injections, NSAIDS, life style changes and knee replacement surgery.
The article is data-light with respect to numbers. The BMJ meta-analysis had a very helpful infographic that details in quantified terms what the measured benefit for arthroscopic surgery is versus conservative management.
The article adequately covers the risks of arthroscopy, noting that the more serious ones are rare.
Although as noted in the summary above, the thoughtful reader will “get” the “be careful what you ask for” message, the article is absent much information about how many patients and institutions the mega-analysis covered; what co-factors were involved in the success or failure of the procedures; how standardized (or not) the diagnostic criteria were; and what the flaws and weaknesses were in the new analysis. Much of this can be found very easily in the BMJ meta-analysis.
There are several sources of quotes and information, and we did not detect any conflicts of interest.
Alternatives are duly noted, and are an important part of the story.
The articles makes clear, if not explicit, that arthroscopy for knee pain is widely available and overused.
The article does a good job explaining that’s what novel here: The course reversal provided by the evidence.
We did not find a news release for this story.
Systematic, Criteria-Driven
The @nytimeswell effort is shown to be unwell once again.
There's pervasive media bias toward hyping treatment benefits while neglecting negative results & harms.
Big part of this is reliance on experts with financial &/or intellectual conflicts of interest.
Att'n journalists: Use this list 100 independent experts to correct imbalance https://twitter.com/garyschwitzer/status/1177189641218330625
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