Dramatically Higher Rate of Knee Arthroscopy in the United States. Are we Getting what We’re Paying For?
A new study released this week has revealed that the knee arthroscopy rate in US is more than double the rates of knee surgery in Europe or Canada. In addition, despite often long knee surgery recovery times, the number of knee arthroscopic surgeries increased by about 1/2 in the decade from 1996 to 2006. There were about 1,000,000 arthroscopic knee surgeries in the United States in the year 2006 alone. About 500,000 of those were for meniscus tears. First, these numbers are staggering. The current US population is about 307 million people, so approximately 1 in 300 people in the year 2006 had knee arthroscopy. If we exclude the patients treated for complete retracted ACL tears (maybe 100,000 patients based on the study)-an indication for knee surgery that we feel is very appropriate to perhaps (not proven yet) reduce the onset of more severe knee arthritis, that leaves about 900,000 surgeries. If we also take out another 100,000 surgeries that are likely performed for knee micro fracture surgery (where there is some low level evidence showing some efficacy in certain younger and male patient populations) and issues like severe locking episodes where a piece of cartilage is in the wrong spot and disabling the patient, that leaves about 800,000 surgeries focused on debridement and meniscus repair. If we assume hospital and physician costs of about $5,000 per surgery and add 25% for dealing with direct surgical complications such as infection, re-operation, etc.., the total United States societal cost is about $5 billion per year. Over a decade, this is $50 billion. While this would be fine if all of this knee surgery resulted in these knees being “fixed”, however the research suggests that this isn’t the case. In particular, the two surgeries we’re discussing that cost 5 billion dollars a year either haven’t been shown to be better than placebo surgeries or there’s current significant controversy over whether they’re effective. As an example, knee debridement surgeries (“cleaning up” the inside of the knee) have been shown to be no better than placebo surgeries. As another example, knee surgery for most meniscus tears may not work well and we’re not sure anymore whether most meniscus tears in middle aged to elderly patients even cause pain. The upshot? We’re spending an awful lot of money on knee surgeries that we don’t know to be effective.