OT: Blue Cross Knee

[buddybikes]

Blue cross of MA (and sure they are sharing nationally) has now eliminated both arthroscopic knee surgery for arthritis and torn meniscus, as well as synvisc type of injections. Only options are steroid shots or total knee replacement.

Insane, my left knee was cleaned out last year, got some orthovisc in it and all is well. Right knee my orthovisc has worn out... There is a published study done by some too smart ortho society that said neither works.

...sitting here working after my lunch ride with ice bag on my knee.

[MattTuck]

That sucks if they took an effective treatment off their program. What is the cost to get it done off plan? (ie. not the retail amount that the dr charges, but the actual amount billed to uninsured patients)

Also, fyi.

http://guardianlv.com/2014/04/ice-age-melting-rice-may-no-longer-be-the-treatment-of-choice-for-injuries/

[josephr]

see if your Doc will get you one these bad boys --- you're set!!!

[tiretrax]

That is completely stupid. My knees have been great for 9 years since getting them scoped. With recent litigation over joint replacements, I have little faith in that remedy (if you could call it that).

[VTCaraco]

My understanding is that the replacement is still a very finite decision. My missus just turned 50. Doc says he's replaced knees that are in MUCH better shape than hers. She does all she can to forestall what feels like the inevitable replacement in hopes of either advancement in technology or a sense that one replacement will be enough.
She's had all that is mentioned (scope, micro-fracture procedure to try (in vain) to create some cushioning, and lubricant injections). All have provided more and better relief than the multiple injections she's tried.
As much as I try to trust the expertise of folks, I wonder.....

[Plum Hill]

I'm having a total knee replacement on the 15th.
My doctor would not do arthroscopic surgery to remove the arthritis. He said 80% of his patients that had it ended up getting a complete replacement within a year. He says he cuts out needless pain and costs.
A cycling friend went through the AS and replacement within a year with a different doctor, so there must be truth in that opinion.

[schneiderrd]

As the recipient of a double TKR (not both at the same time) I can agree that scoping may not do much, it didn't for me. The synvisc worked for awhile but eventually the TKR was my only option. My advice to anyone considering a TKR, if your life is not impacted substantially by you knee pain wait. If you can't go up and down stairs or ride your bike you don't have any choice. If you have the TKR, follow the instructions exactly. Don't slack on the after PT surgery, but don't over do it either. If you can get away with out the nerve block at the time of surgery, I would tough it out. I had it and I have some residual nerve problems. Good luck;)

[Plum Hill]

If you can get away with out the nerve block at the time of surgery, I would tough it out. I had it and I have some residual nerve problems.)

Are you referring to the spinal in lieu of a general anesthetic, or the shot in the hip at the end of surgery?

[ultraman6970]

Medical insurance companies sucks lately!!!!

[bargainguy]

I believe this centers around the latest study which concludes physical therapy is just as effective - if not more so - than arthroscopic meniscectomy for meniscal tears and the like.

When arthroscopy was first developed for the knee, it was thought all that needed to be done was to shave out damaged cartilage. That cartilage will never grow back. Another thought was to scar the cartilage with holes to stimulate a healing response - that doesn't work well either. Seems the orthopedic profession is swinging back to open surgeries or nothing.

When I worked in the medical field, I saw thousands of arthroscopic knee surgeries. Never had one myself, but I distinctly remember a woman in the office who had one - then couldn't understand why she didn't feel any better after surgery and still doesn't to this day AFAIK. Could have been the typical case they were describing in the study.

[nooneline]

steveandbarb1 and tiretrax, what you two are describing sounds like the post hoc ergo propter hoc fallacy (http://en.wikipedia.org/wiki/Post_hoc_ergo_propter_hoc). Sorry for the obnoxious act of dropping latin, but that's what it's called. It's when you attribute the difference between before & after to what separated the two - whether or not it's actually responsible for change.

When Blue Cross MA takes a type of surgery or other treatment off the table, they don't do so by by asking, "did steveandbarb1's knees feel better after this type of surgery?" What they do is collect data on thousands of surgeries, and they analyze the bulk results: did people who had surgeries have, as a group, better outcome than people who had other interventions? Like the Canadian study that identified the fact that regular mammograms DON'T save lives.

Yes, these decisions are made by also asking what's going to get the most bang for the buck. But saying "my knee surgery made me feel better" is one data point among millions.

[schneiderrd]

Quote: "Are you referring to the spinal in lieu of a general anesthetic, or the shot in the hip at the end of surgery?" I'm talking about the one they gave me in the back before the knocked me out for the surgery. While they say there is little risk, to me it wasn't worth it. I wore off a few hours after I was back in my room, but with the lingering problems I have now I would gladly take some pain.

[FlashUNC]

Are you referring to the spinal in lieu of a general anesthetic, or the shot in the hip at the end of surgery?

Quote: "Are you referring to the spinal in lieu of a general anesthetic, or the shot in the hip at the end of surgery?" I'm talking about the one they gave me in the back before the knocked me out for the surgery. While they say there is little risk, to me it wasn't worth it. I wore off a few hours after I was back in my room, but with the lingering problems I have now I would gladly take some pain.

I had a slightly different nerve block for my elbow post surgery. Inserted a line into a nerve just at my neck/shoulder junction for my right arm. Attached that to a small pump and anathestic bag that then went everywhere I went for the first 72 hours after surgery. The Boss called it my drug purse. Once the anesthetic was exhausted, the line was removed.

It definitely helped with blocking out the worst of the pain post surgery, but it did have some interesting side effects. The drugs caused me to get a bit droopy on the right side of my face as the built up in my system. Which coupled with various other painkillers did wonders for my speech and general mood.

On the plus side, I didn't have any lasting effects from my block, so ymmv.