Upper Limb
Knee surgeons were in the firing line last year, with TKR declared a ‘procedure of limited worth’ in the UK and permission to carry out arthroscopic procedures relying on the say-so of clerical workers.
I doubt it has escaped political attention that, according to a Research Strategy Workshop organised by Arthritis Research UK, the rate of shoulder arthroscopy in the USA now exceeds that of knee arthroscopy.
The rate of rotator cuff repair in the UK has increased 5 fold, and subacromial decompression 7 fold, in the last decade – a pattern that no doubt is mirrored across many nations. Professor Andrew Carr gave a typically understated paper at the British Elbow and Shoulder Society meeting in Gateshead, UK demonstrating how this data can be, and indeed is, presented in an atlas of variation mapping out exactly who is ‘overtreating’ that would make politicians see red – if it were not printed in shades of blue.
We have seen a lot of excellent research in shoulder and elbow in recent years; it is a real growth area. However, we are going to have to look carefully at why we operate and when, and show that our interventions are timely and the best thing for the patient in the long term. If we don’t, it will cost us and the knee surgeons an arm and a leg. And think on – around the world more and more attention is being paid to the revalidation or relicensing of doctors and undoubtedly this will rely on the analysis not of our own data, collected for our own studies, but on the information collected and coded not by us, but about us.
As Einstein said ‘information is not knowledge’ – we are better placed to explain variations in practice than politicians or economists looking at a map. Let us help this process, not hinder it, and put our own house in order when necessary. What better forum for powerful messages than a peer-reviewed journals like JBJS (Br) and Bone & Joint Research.
Mr David Limb, Consultant Orthopaedic Surgeon, Leeds Teaching Hospitals Trust, UK
