The representative groups for orthopaedic surgeons has been forced to apologise after putting out a public statement claiming GPs are to blame for patients undergoing needless keyhole knee surgery.
The British Orthopaedic Association (BOA), in a joint statement with the British Association for Surgery of the Knee (BASK), said patients were being set up for failed arthroscopy because GPs were over-diagnosing patients with non-arthritic complaints and referring them on with the expectation the surgeon would ‘cure’ the problem with the keyhole procedure.
It also claimed GPs were not ‘doing their job properly’ by failing to prescribe exercise to patients before referring them for surgery.
This sparked fury from GPs, including Hampshire GP Dr Michelle Sinclair, who accused the groups of being ‘patronising, arrogant idiots’, while others pointed out that they ‘refer to get an expert opinion, not an operation’ and that the BOA/BASK response amounted to ‘unbelievable peer-bashing’.
RCGP chair Professor Maureen Baker tweeted that she was ‘outraged and saddened’ by the statement.
However, the groups quickly moved to apologise to GPs, saying it was not their intention to ‘criticise or offend’.
The original statement by the orthopaedic groups was in response to a BMJ paper – widely reported in the lay press – in which experts said arthroscopy should be phased out.
They argued it offers only very limited reductions in pain while putting patients at risk of life-threatening complications such as deep-vein thrombosis.
The team said that one reason so many patients are still undergoing the procedure – some 150,000 in the UK every year – is because surgeons were biased in their belief it worked.
BOA/BASK hit back with a statement to their members and patients asserting orthopaedic surgeons only offered arthroscopy when it was appropriate and that many patients with arthritis were wrongly being referred by GPs for the procedure.
The statement began: ‘Many GPs have direct access to MRI scanning, believing that performance of this investigation replaces the traditional medical skills of history taking and physical examination of the patient.’
It continued: ‘If MRI scanning is performed too early in the investigative pathway then over diagnosis of meniscus lesions predominates. Very often the arthritic knee has an associated and often irrelevant meniscus tear. The MRI scan result then triggers referral to an orthopaedic surgeon with the expectation by the patient that the knee problem can be “cured” by a knee arthroscopy.’
BOA/BASK also said that – contrary to the paper’s assertion that patients should be advised to take exercise instead of going ahead with surgery – GPs should already have tried this before referring a patient.
The statement read: ‘It is stated that such patients should be treated with exercise, but if GPs are doing their job properly, exercise should already have been prescribed in primary care.’
However, following Professor Baker’s intervention on Twitter, the groups issued an apology.
They said: ‘Following the response to the BOA/BASK statement regarding knee arthroscopy dated 19 June we would like to clarify that our intention was not to criticise or offend GPs. The aim was to highlight the gaps in the MSK general knowledge base and we apologise to our colleagues.’