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Knee arthroscopy on NHS no more?

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Just heard snippet on BBC radio news. Arthroscopy on knees affected by osteo arthritis is one of the 20 or so procedures likely to be withdrawn from NHS treatment menu.
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Crying or Very sad
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They are claiming the ones being removed are “ineffective”. Is that the case?
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At least one paper quoting two RCTs suggests it’s not effective, “Arthroscopic surgery for knee osteoarthritis? Just say no” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183924/

So it shouldn’t be done, on the NHS or not.
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@NickyJ, here’s the BMJ on it, https://www.bmj.com/content/357/bmj.j1982:

ineffective
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Thanks. I know it is something my Dad had and I thought it did improve things for a while. Will read the article - maybe it is the fact that overall it is only a short term improvement.

Particularly interested as told repeatedly I will suffer from this due to the amount of damage / surgery I have had on my knees.
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The second link didn’t work for me?
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@NickyJ, looks like it’s one of those, “we’ve always done it, so it must work”, procedures.
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If all these procedures are ineffective, are the surgeons that routinely carried them out to be prosecuted.
It’s all about the money.
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Hmm just going through this at the moment - but private coverage so up to me. My knee has been "jamming" a few times this summer but consultant says it's 50-50 whether trimming the meniscal tear that's been there 9 or more years will help because it could be an arthritic hotspot that shows on the MRI. Will probably get it done as 50% chance of improvement is tolerable to mr.
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I believe that it is only arthroscopy for OA that is mentioned not arthroscopy for ligament damage etc which might be of more relevance to skiers!

@jbob, to say those procedures are ineffective is a bit misleading. I do some of the 17 listed (not arthroscopies) and those that I do are effective as in they work (all on NHS so no benefit to me personally whether I do them or not) however there are often alternative less invasive options for treatment and others can be avoided in the majority of people.

This is about seeing what NHS procedures can be reduced to save money but without harming patients health (those that I do are often but not always desired by patients for mostly cosmetic reasons). Ironically, it will probably encourage/force more patients to have these done privately so better for income!!
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@Dave of the Marmottes, that said, I had meniscal jamming in 2013 which resolved itself in 18 months ... no recurrence (not formally diagnosed I must admit)
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@jbob, from what I read and not being a medic but being somewhat close to the field, these are in some cases either cosmetic as @DrNo says or, in the OA knee case a revision of revised standard of care.

So nonreason to prosecute anyone Happy
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@Dave of the Marmottes, that said, I had meniscal jamming in 2013 which resolved itself in 18 months ... no recurrence (not formally diagnosed I must admit)
Same here. Surgeon said it would be better to leave it alone and hopefully it would settle down. He said going in was only going to put more wear on the knee.
12 yrs ago though
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I have dupetrons? Which is going to be stopped. Not sure how I am going to hold my ski poles in years to come.
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Consultant said it was ineffective in 1987 when I was knocked off my moped
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@DrNo,sorry I wasn’t suggesting that individual NHS Doctors were doing unnecessary procedures for the money, rather that this was more about the health of NHS finances than that of the patients.
Listening to a number of medics on the radio today the clinical guidelines they already work to, don’t encourage unnecessary operations. There was a vascular surgeon who described in detail in what circumstances he would do varicose vain operations which seemed entirely appropriate. Makes me wonder why someone chose to make this announcement today.
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@jbob, on the choosing to make an announcement, probably to feed the enormous cover up over how badly Brexit is going...
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And as usual, the mainstream media are not reporting the whole story ... rolling eyes

It’s probably too complicated.
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jbob wrote:
. ... It’s all about the money.
Actually it isn't at all.

Take the example of Homeopathy, which was only just withdrawn as a tax-payer funded option late last year. There has never been any evidence for that, yet your and my money was wasted on it. It wasn't actually wasted much - almost no NHS clinicians would countenance it. That's not because of "the money", it's because it's pointless, it breaks trust, and it may prevent patients seeking treatment. There's no financial interest for (say) a GP either way.

Many politicians would rather waste money than suggest that their voters might be wrong.
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@philwig, It is at least partially about the money!

Whilst I can't comment on the majority of the 17 procedures from an expert perspective, I think they all have some value in selected cases and the ones that I do of those are effective in almost all cases at achieving a certain aim.

The point is however that this aim is cosmetic and rightly or wrongly, people feel it is appropriate that the NHS doesn't offer cosmetic procedures. To put it another way, if the NHS had unlimited financial resources, I am sure a number of those procedures would be continued to be performed in the majority of cases as they are today!

I don't think that you can compare this to homeopathy as that is not a healthcare intervention, merely a way to utilise the placebo effect
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Arthroscopy is merely looking into a joint to see how it is and how it performs: it is a diagnostic procedure.
Various (endoscopic) operations can then be performed: so-called "key-hole" surgery.
It is arthroscopic debridement/washout that is being challenged: the idea that washing out accumulated rubbish in the joint will improve function and lessen pain in patients with osteoathritis.
The BMJ review advises against this procedure for osteoarthritis of the knee.

The announcement has been mis-reported in some areas.
No procedures have actually been totally banned.
Four procedures will only be offered at the request of a patient: Snoring surgery, Dilation and curettage for heavy menstrual bleeding, Knee arthroscopies for osteoarthritis, Injections for non-specific back pain.
A further 13 treatments will only be offered when certain conditions are met: Breast reduction, Removal of benign skin lesions, Grommets for glue ear, Tonsillectomy, Haemorrhoid surgery, Hysterectomy for heavy menstrual bleeding, Removal of lesions on eyelids, Removal of bone spurs for shoulder pain, Carpal tunnel syndrome release, Dupuytren’s contracture release, Excision of small, non cancerous lumps on the wrist called ganglia, Trigger finger release, Varicose vein surgery.
https://www.theguardian.com/society/2018/jun/29/nhs-wields-the-axe-on-17-unnecessary-procedures
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@Jonpim, thank you. Good to have the whole story.
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@Jonpim, yes, useful clarification and detail.

I had knee arthroscopy /debridement and meniscus chopping a couple of years ago.

My opinion is that it seemed to improve knee condition enough to feel worthwhile. Possibly delaying the need for a replacement knee by a year or three?

Also my impression was that without arthroscopy, ie going in and having a look, definite diagnosis is difficult. Even MRI scans don’t give definitive diagnosis.

Any expert thoughts on that anyone?
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