Routine x-rays for knee osteoarthritis are not only unnecessary for diagnosis but can also influence patients to consider joint replacement surgery prematurely. A new study reveals that patients shown x-ray images of their knees are significantly more likely to believe they need surgery, even when non-surgical treatments would be more appropriate.
The Problem with Imaging
Osteoarthritis (OA) is a common joint condition, often arising from the natural aging process, high body weight, or prior injuries. While many experience pain and limited mobility, the extent of joint damage visible on an x-ray doesn’t correlate with the level of pain someone feels. Some people with minimal joint changes experience severe symptoms, while others with substantial changes feel little discomfort.
Despite this, nearly half of new knee OA patients in Australia are still referred for imaging, costing the healthcare system over A$104.7 million annually. This is counter to clinical guidelines, which recommend a diagnosis based on age (45+) and symptoms – pain with activity and minimal morning stiffness.
How X-rays Shift Perceptions
Researchers conducted a study with 617 Australians, randomly assigning them to view one of three hypothetical doctor’s consultations. One group received a clinical diagnosis without x-rays, while the other two had x-rays, with one group shown the images. The results were striking: participants who saw their x-ray images had a 36% higher belief that knee replacement surgery was necessary.
They also perceived exercise as potentially harmful and expressed greater fear of worsening their condition. This is likely due to the common misconception that OA is simply “wear and tear,” leading people to assume visible damage requires surgical intervention.
Why This Matters
The study highlights a dangerous trend: over-reliance on imaging can fuel unnecessary anxiety and demand for invasive procedures. Knee replacement surgery is costly (over $3.7 billion in Australia in 2020-21) and carries risks like infection and blood clots. Effective, less invasive treatments include education, exercise, weight management, and pain medication.
“Our findings underscore the importance of avoiding unnecessary x-rays for knee osteoarthritis. Changing clinical practice may be challenging, but reducing these scans could ease patient anxiety, prevent unwarranted surgical concerns, and lower healthcare costs.”
The focus should shift from “fixing” joint damage to managing symptoms and improving function through proven non-surgical methods. If you have knee OA, remember that routine x-rays aren’t needed for diagnosis or treatment decisions.
Ultimately, this research reinforces that patient perceptions and treatment decisions are powerfully influenced by what they see, even when the medical evidence doesn’t support it.
