LAUSR

Arthroscopy heralded an age of surgery-as-frontline-treatment for the painful joints of middle-aged and older people. By the end of the 20th century, knee, shoulder, hip and ankle arthroscopies were some of the most frequently performed surgeries in developed countries.1 Questions were first raised about the efficacy of knee arthroscopy for advanced osteoarthritis in 2002, when Professor Moseley and colleagues published their landmark placebo-controlled trial.2 Similarly, rigorous trials followed, each questioning the efficacy of arthroscopic partial meniscectomy and subacromial decompression—the two most common arthroscopic surgeries. Despite compelling, high-quality evidence, why did the number of arthroscopies for degenerative conditions continue to rise in the first decade of the 21st century?1 The most obvious change to clinical practice was that arthroscopies were increasingly billed using different procedure (billing) codes.3 Our Finnish colleagues investigated the trends in various arthroscopic surgeries in Finland between 1997 and 2016 and found that the incidence of knee and shoulder arthroscopy peaked in 2006 and 2007, respectively, then steadily declined.1 The rates of wrist, elbow and hip arthroscopies also declined after their 2014 peak.1 Although the rates have declined in some countries, arthroscopies for patients with degenerative joint diseases remain some of the most commonly performed surgeries around the world. The Finnish Centre for Evidence-Based Orthopaedics (FICEBO, www.ficebo.com) has been studying arthroscopic surgery for …