Monday, October 27, 2008

Osteoarthritis (OA) is no doubt a growing cause of loss of function in our society. MSNBC's Health department recently reported on this growing epidemic related to total joint replacements. They are worth a watch. The first video found here discusses the financial impact on Medicare and the second seems more of a marketing clip for total joint replacements. What caught my ear was in the second video the surgeons comments on why total joints. To paraphrase he states total joints are done when "conservative" treatments don't help. He lists conservative treatments as "medications and drugs..". Wow, is it any surprise that these failed? Not many of us can manage chronic progressive pain with medications.

What is disappointing is the utter lack of mention of what literature shows helps and what is a first line recommendation for pain and dysfunction related to OA. That is Physical Therapy. PT is less expensive, can lead to independence in pain management, has good long term outcomes, and has little to no potential negative effects. These qualities are almost completely opposite of what pills and injections offer.

I've seen total joint replacements completely change a persons function, but if we truly want to decrease costs of conservative management of joint pain, we need to shift away from expensive drugs and injections, eliminate unnecessary imaging, and encourage the return of individuals control over their physical well being.

So, you've got drugs, you've got surgery, or you've got Physical Therapy. Let's let individuals know about their choices.

Jason L. Harris

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