Is it a good idea to have bone or joint surgery? Surgery may not be more effective than other options.
Hip and knee replacements, carpal tunnel syndrome, and other orthopedic procedures are some of the most common surgeries performed today, but they cost, risk, and sometimes weeks or months of recovery. A review found that many of the surgeries are not supported by randomized trials. The review concluded that surgery may not be better than non surgical care.
British researchers looked at studies of 10 common operations. There was good evidence that surgery was superior to other treatments for carpal tunnel syndrome. Randomized trials found little advantage over interventions for six other common surgeries. There were no controlled trials that compared hip replacement or knee repair. The study is in a journal.
The lead author of the study said that they didn't show that operations don't make patients better. Treatments do not work if they have not been tested in randomized controlled trials. It's just that some don't work as well as the best non surgical treatments.
Dr. Saam Morshed, a professor of orthopedic surgery at the University of California, San Francisco, who was not involved in the study, said, "I think it's fair that we hold the mirror up to ourselves and scrutinize effectiveness for some of these operations." It is important to understand where there are gaps in knowledge of the efficacy of surgical treatments.
He said that it was important to understand that the treatment was effective even if there wasn't a randomized trial. He said that hip surgery is a good example. There is no randomized trials of hip surgery, but there is overwhelming evidence for its effectiveness.
The picture may be different in other procedures. The rate of success for an operation to repair the anterior cruciate ligament in the knee is as high as 97 percent in some studies. There was no difference in pain scores or the need for further treatment when the operation was compared with non surgical treatments.
The rotator cuff is a group of muscles and tendons that hold the shoulder in place. The review found that there was little or no difference in pain, function, quality of life or patient satisfaction with the results of steroid injections.
One group of patients were given real surgery and the other was given a placebo. There was no difference in outcomes between surgery and placebo in two studies of shoulder impingement.
A pinched nerve in the lower spine can be caused by a bulging disk. The quality of the evidence was low, but three analyses showed that surgery and non surgical treatments provided the same improvements.
There were no studies that compared surgical repair of the meniscus with non-operative care or a placebo. In 10 randomized trials, the operation known as meniscectomy, or partial removal of the meniscus, did not improve knee pain, function or quality of life.
It should not be assumed that the most cost-effective options for patients are the physical, medical and psychological interventions. Patients can make informed choices if clinicians discuss both the best and the worst nonoperative care with them.
The patient outcomes from these surgeries vary greatly. Future research will provide more nuanced inferences on the effect of surgery as we begin to understand on a patient level those characteristics that make them more or less likely to respond to a procedure.
