Nathan Wei’s Blog

Knife-happy surgeons? June 10, 2009

[I thought this was a real good indicator of a couple of things.  The first is that the health care system is too focused on treatment rather than prevention.  And that orthopedic surgeons do far too many joint replacements. 

Most joint replacements are done for arthritis.  The emphasis should be on slowing the disease process and maybe even reversing it, rather than subjecting a patient to a potentially dangerous – even life-threatening- procedure.  The point CBS was trying to make was that informed consent- the process where risks of a procedure are explained to the patient- is confusing and most patients don’t understand what’s going to happen.  And that’s true.

I have many patients who have gone through joint replacement and are happy… however, I also have a significant number of patients who have had bad outcomes and rue their decision.  Too late!

That’s why more emphasis should be placed on regrowth of connective tissue- ie. prolotherapy, the use of natural growth factors such as platelet-rich plasma (PRP) and the use of stem cells to regrow cartilage.  Natural healing.

There are efforts now at some centers evaluating the use of stem cells for spine-related disorders.

Our experience with the implementation of an autologous stem cell program (using the patient’s own stem cells harvested from their bone marrow) for osteoarthritis of the hip and knee  is proving that tissue regeneration is an option- a far better one that joint replacement.  That’s why the orthopods are so angry with us!!!]

Study indicates informed consent forms may be of “limited value.”

The CBS Evening News (6/9, story 10, 3:45, Couric) reported that “the high cost of medical care is a huge issue today, and…patients often make the problem worse by giving doctors permission to do procedures they don’t need. Experts point to four procedures — coronary angioplasty, spinal fusion, knee replacement, and hip replacement — that are responsible for billions of dollars in hospital costs every year.” In fact, data indicate that 30 “to 40 percent of those procedures are considered unnecessary.” But, Dr. Elliott Fisher, the Dartmouth Institute for Health Policy, noted that “proper informed consent would eliminate 30 to 40 percent of other unnecessary expensive procedures.” He explained, “The problem starts with consent forms. A review of hundreds of consent forms at more than 150 hospitals found them to be of, quote, ‘limited value.’ They are not standardized, loaded with confusing language. They are often missing specific risks, and generally not well explained by doctors.”