Experts call most common orthopedic surgery “inappropriate” or “inconclusive”

When I was in medical school at Penn, we put on a variety show at the end of every year. One year, we based a skit on the popular musical Fiddler on the Roof and it spoofed the different medical specialties. The verse about orthopedists went like this (set to the tune of the number called “Tradition”):

“I barely passed my boards.

They said I had no chance.

But I went into ‘bones and joints,’

and now own two-thirds of France.


And we wrote this even before the joint replacement industry took off. These days, if any specialty in medicine qualifies as “big business,” it’s orthopedics. This field earns its dubious reputation quite on its own. In fact, a new study found that 34 percent of one common orthopedic surgery performed in the U.S. is entirely “inappropriate.”

Actually, my primary care physician recently referred me to an orthopedic surgeon about a little bump on my toe. The orthopedist looked at the full set of x-rays. (And, I will give him some credit–he did actually look at the toe also.)

But he said he could not tell what the bump was without doing a $1,000 MRI with his own fancy new CAT scan machine (for which they were probably paying in installments). He also vaguely hinted the bump might be tumorous. Whether that comment came from just plain ignorance, greed, or both–I don’t know. But I promptly walked out, toe and all.

I don’t mean to make light of orthopedic problems. In fact, degenerative osteoarthritis and joint pain are huge issues among aging men and women. Especially among those who over-exercised on hard, manmade surfaces. The human body just isn’t designed for repeated pounding on the pavement for mile after mile, day after day.

In fact, this growing trend of extreme exercise ties directly to the growing number of unnecessary orthopedic surgeries (not to mention potentially fatal heart arrhythmias). The number of total knee replacement surgeries done each year more than doubled between 1991 and 2010. And a group of U.S. researchers recently set out to determine how many of these surgeries are medically necessary.

They analyzed records for 205 patients with knee osteoarthritis from four different locations who underwent knee replacement surgery. The patients’ average age was 67 years. And 60 percent of the patients were women.

The researchers used a system developed in 2003 to classify total knee replacement as appropriate, inconclusive, or inappropriate. The system is based on symptoms, functional status, extent of arthritis, age, mobility, stability, and history of non-surgical and surgical treatments.

They found less than half (44 percent) of the surgeries were “appropriate.” Twenty-two percent were “inconclusive.” And more than one-third of them were (34 percent) blatantly “inappropriate.”

Most patients in the “appropriate” category were 55 years or older and had intense, severe pain with limited mobility. Patients in the “inconclusive” category were similar, but most still had normal mobility.

But patients who had received “inappropriate” replacements had only slight or moderate symptoms. In fact, they experienced half the pain and loss of mobility of the average knee-replacement patient. It was also common for them to be under 55 years old. Experts at Brigham and Women’s Hospital (Harvard Medical School) in Boston commented that total knee replacement “might not be appropriate” for patients with milder symptoms.  Plus, the younger you have a knee replacement the greater the odds you will eventually require another one, and another after that.

But I’ll offer a more definitive conclusion: You should only consider total knee replacement if nonsurgical treatments have failed.

Fortunately, many natural remedies can decrease joint pain and improve mobility. Including Boswellia (frankincense, 450 mg/day), Ashwaganda (winter cherry, 500 mg/day), and the simple spice turmeric or curcumin (200 mg/day). These remedies have anti-inflammatory properties that help control inflammation and damage, and reverse degeneration of the joint cartilage.

Many vitamins and minerals also help nourish the bones and joints. Including vitamins C (500 mg/day), D (5,000 IU per day), E (50 IU per day), magnesium (150 mg/day), and boron (5mg/day). Also, make sure to get plenty of calcium and phosphorus from your diet.

Of course, this natural prescription is not recommended by mainstream medical doctors. Much less by the “bone and joint” physicians. But before you sign up for their magical, invasive, and expensive carpentry–I mean surgery–make sure you first give these natural approaches a fair try. Natural healing of years and years of damages can take months of the appropriate supplements.  But now you know it’s worth the wait.. And in my next Daily Dispatch I’ll tell you about another kind of “joint” replacement that is well worth considering. Stay tuned.


  1. “Use of a Validated Algorithm to Judge the Appropriateness of Total Knee Arthroplasty in the United States: A Multicenter Longitudinal Cohort Study,” Arthritis & Rheumatism, June 30, 2014, published on line
  1. “One-third of knee replacements in the U.S. may be inappropriate,” Reuters ( 6/30/2014