Do You Need This Surgery?

More than 70 million Americans face surgical procedures every year. Are they all necessary? Probably not. Even the simplest operation is a serious undertaking. “No surgery is minor,” says Dr. Thomas Russell, executive director of the American College of Surgeons. There is always a possibility that something can go wrong when someone sticks a sharp blade in your body.

Sometimes surgery is the only available treatment. In other cases, however, less-invasive options should be tried first. Whether or not you go under the knife may even depend on where you live. “There’s evidence that in some parts of the country, certain procedures are overdone,” says Dr. Russell. “But other communities take a conservative approach and require you to go through hoops and hurdles before you have surgery.”

Clearly, there should be no delay when surgery is the only recognized treatment or you’re in a life-threatening situation. But doctors agree that patients considering elective procedures should proceed cautiously.

Here is some vital information to consider about three of the most popular forms of elective surgery.

Knee Surgery

More than 13 million Americans suffer from osteoarthritis of the knee. In plain language, their knee joints have worn out. Most doctors will try conservative treatments first, including medication for pain and inflammation, physical therapy or joint injections. “To have knee surgery just because you have arthritis is not the solution,” cautions Dr. Jim King, president of the American Academy of Family Physicians.

When the conservative approach fails, however, about one in four people with osteoarthritis of the knee eventually becomes a candidate for total knee-replacement surgery.

About a half-million Americans a year undergo this procedure, known as knee arthroplasty, in which metal, plastic or ceramic replaces all or most of the worn-out joint. It is one of the most successful and established surgical procedures in the U.S. More than 90% of people who get new knees experience significant pain relief, improved mobility and a better overall quality of life. Recovery can be slow and painful, though, requiring months of therapy.

On the other hand, a recommendation for knee arthroscopy—a less-invasive and increasingly popular procedure selected by 650,000 patients in the U.S. last year—should be looked at skeptically. The theory behind the procedure is that arthritis causes loss of tissue at the surfaces of the bones, which painfully chafe against each other and produce debris. The surgeon—guided by a camera inserted at the knee joint—cleans the bone and smooths the surfaces. Unfortunately, several studies have concluded that this procedure is not very effective, particularly against advanced arthritis. In fact, one study found that “sham” surgery—where only a cut was made, though the patient believed a full procedure had been performed—provides as much relief as arthroscopy.

If your doctor recommends arthroscopic surgery, be sure to ask why he thinks it’s necessary and what other options he recommends. If you’re not satisfied with the answers, get a second opinion.