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Overuse Why many hip and knee replacments are not necessary
Why you should be cautious when your surgeon recommends a total hip or knee replacement.

There is a great series of articles in the Lancet about overuse and underuse of medical treatments and testing's. Researchers are finding there are many testing's and treatments that are being overly done, unnecessary and how it can harm patients. There are many reasons for medical overuse. It is good to be aware for your own protection what is going on with overuse and ways to receive the right care.

I will post separately about overuse and underuse.

Series from the Lancet journals
View all Series
Right Care
Published: January 8, 2017

Executive Summary

Many countries struggle with the question about sustainability, fairness, and equity of their health systems. With the focus firmly on universal health coverage as a central part to the UN Sustainable Development Goals, there is an opportunity to examine how to achieve optimum access to, and delivery of, health care and services. Underuse and overuse of medical and health services exist side-by-side with poor outcomes for health and wellbeing. This Series of four papers and accompanying comments examines the extent of overuse and underuse worldwide, highlights the drivers of inappropriate care, and provides a framework to begin to address overuse and underuse together to achieve the right care for health and wellbeing. The authors argue that achieving the right care is both an urgent task and an enormous opportunity.

Harms to patients
Few studies have directly documented patient harms from overuse, however, estimates of physical harm to patients from overuse can be inferred from data on adverse events and studies regarding overuse of specific treatments. For example, Cushner and colleagues160x160Cushner, F, Agnelli, G, FitzGerald, G, and Warwick, D. Complications and functional outcomes after total hip arthroplasty and total knee arthroplasty: results from the Global Orthopaedic Registry (GLORY). Am J Orthop. 2010; 39: 22–28

PubMedSee all References160 used outcomes from a global orthopaedic registry for total knee and hip arthroplasty to estimate a rate of 7–8% for serious adverse events, which included severe infection, revision, cardiovascular events, and death. Other researchers estimate that more than 20% of total knee replacements in Spain and 30% in the USA are inappropriate.35x35Riddle, DL, Jiranek, WA, and Hayes, CW. Use of a validated algorithm to judge the appropriateness of total knee arthroplasty in the United States: a multicenter longitudinal cohort study. Arthritis Rheumatol. 2014; 66: 2134–2143

Crossref | PubMed | Scopus (22)See all References, 161x161Quintana, JM, Arostegui, I, Escobar, A, Azkarate, J, Goenaga, JI, and Lafuente, I. Prevalence of knee and hip osteoarthritis and the appropriateness of joint replacement in an older population. Arch Intern Med. 2008; 168: 1576–1584

Crossref | PubMed | Scopus (112)See all References Thus we can estimate that 2–3% of patients undergoing arthroplastic surgery in those two countries are unnecessarily harmed by an inappropriate procedure, with approximately 14 000 patients suffering harm from unnecessary knee and hip arthroplasty per year in the USA alone. Other examples of documented harm from overuse include high rates of overuse of implantable vena cava filters and low rates of appropriate removal,162x162Sarosiek, S, Crowther, M, and Sloan, JM. Indications, complications, and management of inferior vena cava filters: the experience in 952 patients at an academic hospital with a level I trauma center. JAMA Intern Med. 2013; 173: 513–517

Crossref | PubMed | Scopus (18)See all Referenceshttp://www.thelancet.com/series/right-care

series published in The Lancet called Right Care
Many countries struggle with the question about sustainability, fairness, and equity of their health systems. With the focus firmly on universal health coverage as a ...
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.

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