Challenged to list several questionable procedures that are commonly used in their field, America's joint surgeons came out against custom shoe inserts and two types of dietary supplements. They also discouraged the long-term use of wrist splints after carpal tunnel surgery and an infrequently performed procedure in which doctors wash a painful knee joint with saline. These choices share one thing: None would significantly affect a surgeon's income. "They could have chosen many surgical procedures that are commonly done, where evidence has shown over the years that they don't work or where they're being done with no evidence," said Dr. James Rickert, an assistant professor of orthopedic surgery at Indiana University. "They chose stuff of no material consequence that nobody really does."