Statistics vs Success

Which are you: a statistic or a person with a problem? If you ask the government, or many of the “managed” health care plans, you are seen as a “life”—as in, how many “lives” will be treated and at what cost? If you ask a doctor who has your best interests at heart, you are a person. But if he or she says they must follow a guideline for your arthritis care, walk out. Here is why.

Individual vs Statistic

The guidelines established for many diseases are often outdated, based on pooled statistics from underpowered or biased studies. They are also layered with political agendas. These troubling statements have been well documented in multiple reviews of various medical societies’ guidelines. Let’s look at one example: the guidelines for the treatment of osteoarthritis (OA), supported by all of the major orthopedic health organizations.

Osteoarthritis symptoms occur when the articular cartilage is damaged and the underlying subchondral bone is exposed. This can be caused immediately by trauma or, over time, by wear. Once this happens, the same actions that damaged the cartilage then irritate the exposed bone, producing OA symptoms. These include pain, stiffness, tenderness, inflammation, swelling, and loss of flexibility.  

When a traumatic knee injury damages the meniscus—or when all or part of the meniscus is surgically removed—the articular cartilage protection is also compromised. This results in cartilage-on-cartilage contact and leads, eventually, to more bone-on-bone contact. A similar biomechanical failure occurs when a joint injury damages the ligaments and the repair procedure fails to restore normal stability.

If cartilage damage is not repaired when first confirmed, the area of damage increases. Symptom intensity increases, interferes with work and leisure activities, and results in significant activity limitations. What began as symptomatic OA becomes chronic OA. The patient then experiences debilitating pain, reduced quality of life, and a significant financial burden. This continues until the subchondral bone protection is restored and the biomechanical failure is corrected—or the patient dies (of old age). 

The current strategy for treating OA recognizes only one line of solutions for treating the biological damage and mechanical failure associated with the arthritis. The recommendations are weight loss, exercise, non-steroidal anti-inflammatories, and cortisone. This “solution” ensures that symptomatic OA becomes chronic OA—and that the chronic OA condition lasts for decades. Why? Because the recommendations for symptomatic OA don’t treat the cartilage damage or solve the underlying problem. For chronic OA, the only official guideline recommendation is an artificial joint replacement but only after the patient has lived for decades with the pain or is over 65 years old.

Doctors promulgating the current treatment strategies too often ignore the biologic solutions, while those using the biologic solutions do not publish enough peer-reviewed papers to successfully advocate for those therapies. And since most people stay with their insurance company for only three years or less, the insurance companies have no incentive to care about your future arthritis. 

As a consequence, many patients remain uninformed and in pain.

It does not have to be this way. If the current guidelines were changed to say, basically, “the sooner the repair after injury, the less likely the arthritis,” it would make a world of difference. That’s because torn meniscus, damaged articular cartilage, and key ligaments should be repaired, regenerated, or replaced as soon as possible. The techniques to do so are now widely available. Just as we no longer bathe injured tissues in corticosteroids, which further damage the tissues, we should no longer remove key protective joint tissues and tell the patients to come back—when the pain is too much—for a joint replacement.

Each year over the next decade, an average of 650,000 patients between ages 35 and 84 will receive their first symptomatic knee OA diagnosis, half a million patients will undergo knee replacement surgery. and  9.3 million patients in the U.S. will suffer from chronic knee OA. 

So if you are in a health plan or insurance plan that measures their success only by data gathered from the first few years after treatment, you may be a great statistic—but not a long-term success.

Medically authored by
Kevin R. Stone, MD
Orthopaedic surgeon, clinician, scientist, inventor, and founder of multiple companies. Dr. Stone was trained at Harvard University in internal medicine and orthopaedic surgery and at Stanford University in general surgery.