"Sudden drop in the number of knee surgeries needed"

Since 2023, Belgium has had an "accountability threshold" from the RIZIV (National Institute for Health and Disability Insurance): orthopedic surgeons may not perform more than 45 percent of their meniscus operations on patients over the age of 50. The reason is that our country was the European leader in such procedures, while for meniscus wear and tear, physiotherapy generally produces better results than surgery.

An evaluation report shows that the measure is working. The number of meniscectomies in people over 50 fell from 12,686 (57% of all meniscus procedures) in the year before its introduction to 7,193 (46%) in the year after. The proportion of surgeons who respect the threshold also rose from 23 percent in 2022 to 48 percent in 2024. Notably: Walloon doctors and surgeons under the age of 55 follow the guideline more closely.

Minister Vandenbroucke wants to expand the evaluation to the hospital level. No fines have been issued yet — first there will be a conversation with doctors who exceed the threshold. The expected saving was 5.7 million euros per year, but the actual gain is still unclear because costs may shift to physiotherapy or medication. Prof. Koen Peers (UZ Leuven) welcomes the turnaround but regrets that a government measure was needed to achieve good medical practice.

Alternative treatments for knee pain

In addition to physiotherapy and surgical procedures, there are various minimally invasive treatments that can be considered before surgery is contemplated. Intra-articular injections into the knee joint are an important option:

Hyaluronic acid injections act as a kind of "lubricant" and shock absorber in the joint, which can provide relief in cases of osteoarthritis and wear and tear, and can improve joint function.

Corticosteroids (cortisone) inhibit inflammatory reactions and can reduce pain and swelling relatively quickly, especially during acute flare-ups.

PRP (Platelet Rich Plasma) uses the patient's own platelets, which contain growth factors that can stimulate tissue repair and pain reduction.

At the HAP.GENT general practitioners' practice, these injections are performed by Dr. Hebberecht, under ultrasound guidance. The use of ultrasound ensures that the product is delivered very precisely to the correct location in the joint or around the tendon, which benefits both the safety and the effectiveness of the treatment.