AAOS: Physicians Should Choose Procedures Wisely

The American Academy of Orthopaedic Surgeons (AAOS) recently released a list of specific tests or procedures that are commonly ordered but not always necessary in orthopedic practice. The list is as part of the group’s Choosing Wisely campaign, an initiative started by the ABIM Foundation in 2011.

The ABIM Foundation, founded in 1999, is a non-profit foundation established by the American Board of Internal Medicine to advance medical professionalism and physician leadership in quality assessment and improvement. The group’s mission is to “engage in an ongoing dialogue about medical professionalism by sharing tools and resources with others who are working to build an equitable, affordable and high quality healthcare system.”

The AAOS list identifies five targeted, evidence-based recommendations that can support conversations between patients and physicians about what care is really necessary. Many of the recommendations have some sort of medical device-related impact, addressing the use of a testing procedure, instrument or medical supply.

AAOS makes the following five recommendations to physicians:

• Avoid performing routine post-operative deep vein thrombosis ultrasonography screening in patients who undergo elective hip or knee arthroplasty;
• Don’t use needle lavage to treat patients with symptomatic osteoarthritis of the knee for long-term relief;
• Don’t use glucosamine and chondroitin to treat patients with symptomatic osteoarthritis of the knee;
• Don’t use lateral wedge insoles to treat patients with symptomatic medial compartment osteoarthritis of the knee; and
• Don’t use post-operative splinting of the wrist after carpal tunnel release for long-term relief.

“More than one in four Americans require medical attention due to a musculoskeletal condition and that number continues to grow,” explained Joshua J. Jacobs, M.D., AAOS president. “As orthopedic surgeons, our duty to our patients is to restore mobility and improve their quality of life through evidence-based, high-quality treatment. Our participation in the Choosing Wisely campaign will help shape patient-physician dialogue, which as we all know is the cornerstone of optimal care. Identifying tests, procedures or treatments that show little to no value not only helps our patients by preventing unnecessary care, but will end up saving healthcare dollars.”

The academy’s Choosing Wisely list was developed after months of careful consideration and review, using the most current evidence about management and treatment options, according to officials. AAOS routinely develops evidence-based clinical guidelines and appropriate use criteria as valuable tools to advance the physician-patient communications process and enhance the diagnosis and treatment of musculoskeletal conditions. The final topics selected for this campaign came out of those clinical practice guidelines.

“The academy has shown tremendous leadership by releasing its list of tests and procedures they say are commonly done in orthopedics, but aren’t always necessary,” said Richard J. Baron, M.D., president and CEO of the ABIM Foundation. “The content of this list and all of the others developed through this effort are helping physicians and patients across the country engage in conversations about what care they need, and what we can do to reduce waste and overuse in our health care system.”

During the next year, more than 30 other specialty society partners will release Choosing Wisely lists.

A full list of participating societies can be viewed here. More information can be found at www.choosingwisely.com.

To date, more than 80 national and state medical specialty societies, regional health collaboratives and consumer partners have joined the conversations about appropriate care. With the release of these new lists, the campaign will have covered more than 250 tests and procedures that the specialty society partners say are overused and inappropriate, and that physicians and patients should discuss.