 |
| Picture by Balint Botz from Radiopaedia |
Well, guess what? Taking an X-ray to diagnose knee arthritis may make you more likely to consider potentially unnecessary surgery (Lawford et al, 2025) as well.
Many of my patients who go to a doctor or surgeon for their knee pain end up being sent for an X-ray or even an knee MRI. Many of these patients have osteoarthritis (OA) in their knees. Actually, routine X-rays may not be necessary to diagnose the condition. A skilled and thorough assessment based on symptoms and medical history is good enough to make the diagnosis.
A huge and common misconception is that OA is caused by 'wear and tear'. Research clearly shows that the structural changes seen in a joint X-ray does NOT correspond with the level of pain or disability a person feels. Nor can X-rays predict how symptoms will change.
In fact, X-rays are NOT recommended in Australia to diagnose knee OA. Nearly half of new patients there with knee OA get sent for a knee X-ray and cost their health system A$104.7 million each year.
Researchers in Australia showed that using X-rays to diagnose knee OA can affect how a person thinks about their knee pain and prompt them to consider potentially unnecessary knee replacement surgery.
Many patients with 'terrible' X-rays have no pain while patients with no damage on X-ray have a lot of knee pain. Hence, X-rays are not recommended for diagnosing knee OA or guiding treatment decisions.
The Australian study had 617 subjects across Australia who were randomly assigned to watch one of three videos. Each video showed a hypothetical consultation with a general practitioner (GP) about knee pain.
The first group received a clinical diagnosis of knee OA based on their age and symptoms and were not sent for an X-ray. The other 2 groups had X-rays done to determine their diagnoses (the doctor showed one group thier X-ray images but not the other group). After watching their assigned video, the subjects completed a survey of their beliefs about OA management.
The results showed that the group who received an X-ray based on their diagnosis and were shown their images had a 36 percent higher perceived need for knee replacement surgery compared to those who received a clinical diagnosis without X-ray.
What was worse was, they even believed that exercise and physical activity could be harmful to their joint. They were also worried about their condition worsening and were more fearful of movement.
The subjects were slightly more satisfied with a X-ray based diagnosis than a clinical diagnosis. This may reflect the common misconception that OA is caused by 'wear and tear' and the joint needs to be replaced.
The study's finding shows that it may be important to avoid unnecessary X-rays when diagnosing knee osteoarthritis. Changing this can be challenging, since many people still expect or want X-ray imaging. If we can change this mindset, it will minimize unnecessary concern about joint damage, reduce demand for expensive and potentially unnecessary joint replacement surgery.
In my opinion, we as health professionals should not focus on joint 'wear and tear' since it can make patients more anxious about their conditions and concerned about damaging their joints. There are a range of non surgical, non invasive options that can reduce pain and improve your mobility. Exercise is one of many if you read this Cochrane review.
Our health minister says healthcare spending in Singapore could hit 30 billion a year by 2030 in a Straits Times article just 2 days ago. Perhaps this is an area where we need to be more mindful of unnecessary X-ray imaging and joint replacements to bring healthcare spending lower.
You can read about what actually causes your joints to wear out here if you are keen.
Reference
Lawford BJ, Bennell KL, Ewald D et al (2025). Effects Of X-ray-Based Diagnosis And explanation Of Knee Osteoarthritis On Patient Beliefs About Osteoarthritis management: A Randomised Clinical Trial. Plos One. DOI: 10.1371/journal.pmed.1004537
No comments:
Post a Comment