A study suggests that common bone and joint operations may be no more effective than physiotherapy or treatment with medications.
It discovered the advantages of some of the most commonly performed surgery, including hip replacements and knee repair, were not backed up by high-quality evidence.
Researchers at the University of Bristol looked for studies that compared the clinical effectiveness of ten procedures with no treatment, placebo or non-operative care such as physiotherapy and medications.
They found evidence from randomised controlled trials supporting the better effectiveness of carpal tunnel decompression surgery and total knee replacement over non-operative care.
But no high-quality trials directly compared total hip replacement or knee cartilage (meniscal) repair with non-operative care.
According to the study published in the British Medical Journal, for six other procedures including shoulder rotator cuff repair and lumbar spine decompression, trials found no advantage of surgery over non-operative care.
It concluded that while seven of the procedures had been recommended for use by national guidelines, there’s wasn’t a high-quality body of evidence to definitively support most of them.
Official figures revealed that about one million patients have surgery for musculoskeletal conditions on the NHS each year.
The absence of proof doesn’t mean the interventions are ineffective but it makes it hard to identify the true treatment outcome.
Study leader Professor Ashley Blom, an orthopaedic surgeon, said that an urgent need exists to prioritise investigation and that most generally used and supported orthopaedic procedures had limited and low-quality evidence base relating to their effectiveness and was concerning.
He maintained that interventions may work even if the evidence base had not yet been established or the observational evidence might be so overwhelming that trials would be regarded unethical or redundant, and that hip replacement might be an illustration of this.
Dr Benjamin Ellis, of the charity Versus Arthritis, said that there should be no place in the NHS for operations that don’t work, but that data from millions in the National Joint Registry has shown the benefits people get from hip and knee replacement surgery.
Bob Handley, president of the British Orthopaedic Association, said that the study had taken a narrow view of the evidence available for orthopaedic operations, and he said that in particular, total hip replacement, was one of the most successful and cost-effective of all operations, not just in orthopaedics.
I’m sure that walking with two artificial hips is much better than hobbling around in agonising pain, and numerous people would tell you that having hip or knee surgery gave them back their life.
I mean who would want to be limping around basically bone on bone? And this is total nonsense because without replacement of joints they’re sentencing people to a life of incapacity and chronic pain.
Countless people are waiting for hip or knee replacement surgery where the bone is on bone, and they’re in agony, not even being able to walk to the end of the road, and it’s no solution to keep giving these people more painkillers, but no doubt this data will now be used as an excuse to cut the waiting lists back down, by dishing out even more painkillers for the benefit of the pharma industry.
And people who need surgery can’t live with the instability, and when they do have the surgery, they don’t regret it one bit because their stability is back and they can safely return to an active life without fear of falling.