Orthopedic surgery addresses injuries to or deformities/disorders of the musculoskeletal system; that is, bones and the soft tissues that support them, including muscles, tendons and ligaments. Although many orthopedic surgeries are necessary and improve a patient’s condition, many are performed needlessly, and can leave the patient worse off.
One reason for orthopedic overtreatment is that the provider has a conflict of interest. Many orthopedists have a financial stake in surgery-related businesses, such as imaging facilities, surgical centers and distributorships for surgical equipment. Any good businessperson wants to grow his or her company, but when the company is about medicine, its customers — patients — can end up paying for its growth in more ways than just financial. They can pay with their health.
If an orthopedic doctor who owns an MRI machine, or has equity in a surgical facility, also is diagnosing a patient’s stiff knee, he or she is more likely to prescribe an MRI than an X-ray, even if an objective review would find the X-ray more appropriate, not to mention much less expensive. He or she is more likely to recommend that the patient go under the knife than to try a course of physical therapy.
The federal Government Accountability Office has documented that physicians who own businesses refer more procedures than those who don’t.
When overtreatment moves from being needlessly expensive to actually harming someone, it’s time to talk to a lawyer. Diagnostic harms can result from the side effects of a CT scan to view a bone spur, using as much as 1,000 times the radiation of a conventional X-ray, or about a year’s worth of radiation exposure from the natural and artificial environments. More often, they occur from having surgery that wasn’t necessary, that uses defective equipment or is performed poorly. (See our backgrounder on surgical error.)
Often, orthopedic surgery should be the last treatment of choice, not the first — orthopedic injuries frequently respond well to less invasive treatments such as physical therapy.
The following list of orthopedic procedures isn’t comprehensive, but it highlights some that are frequently performed, are often unnecessary and expensive, sometimes harmful and that are vulnerable to conflicts of provider interest. If you have suffered a poor outcome from any of them, it might be time to speak to a lawyer.
Note: Although providers often have conflicts of interest if they have a financial stake in implant devices or the distributorship for them, surgery that involves devices such as hip implants often is necessary, so those procedures are not included in this list.
Arthroscopy for arthritis: Harms from this surgery might be infection, deep vein thrombosis and pulmonary embolism.
Vertebroplasty for a fractured vertebra: Harms from this surgery intended to relieve pain might be infection, compression fractures in adjacent vertebrae, tears in the tissue covering the spinal cord and nerves, migration of the repair material outside of where it’s supposed to be and nerve pain. (See our backgrounder on spine surgery and our other backgrounder on nerve damage.
Rotator cuff repairs, especially for older patients: Harms from this surgery include infection, bleeding, re-rupture of the rotator cuff, nerve damage and blood clots.
Clavicle (collarbone) fracture repair, especially for adolescents hoping to improve their athletic performance: Harms from this surgery, known as “plating,” include infection, collapsed lung, pain and limited strength and/or range of motion.
Anterior cruciate ligament tear repair/reconstruction in patients at low risk of recurrence: Harms from ACL surgery to the knee joint include infection, instability, stiffness, pain, kneecap fracture and damage to the ends of the bones in children.
Removal of torn meniscus: Harms from this surgery to cut out portions of damaged cartilage that cushions the knee joint include infection and no relief from pain, lack of strength and stability.
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