Common Elective Orthopedic Procedures: Does Research Support Their Use?
Elective orthopedic procedures are among the most commonly performed surgeries. Although there is usually identifiable pathology (eg, osteoarthritis, degenerative disc disease, spinal stenosis) that could be considered an indication or these procedures, most are usually performed to reduce or eliminate pain and improve function.
It could be assumed that the efficacy of these procedures has been supported by high quality evidence, particularly randomized controlled trials (RCTs), but a recent umbrella review published in the British Medical Journal calls this into question. Researchers examined meta-analyses of RCTs or of other study designs in absence of RCTs to compare the effectiveness of the 10 most common elective orthopedic procedures with no treatment, placebo, or non-operative care.
In the slides below, find a recap of the findings for each procedure and key takeaways for your clinical practice.
1. Arthroscopic anterior cruciate ligament reconstruction for ligament rupture
2. Arthroscopic meniscal repair for traumatic tears
3. Arthroscopic partial meniscectomy of the knee for degenerative meniscal tears
4. Arthroscopic rotator cuff repair for acute rotator cuff tear
5. Arthroscopic subacromial decompression for subacromial impingement syndrome
6. Carpal tunnel decompression for carpal tunnel syndrome
7. Lumbar spine decompression for spinal canal stenosis
8. Lumbar spine fusion for degenerative disc disease
8. Lumbar spine fusion: What did researchers find?
9. Total hip replacement for end stage osteoarthritis
10. Total knee replacement (TKR) for end stage osteoarthritis
Of the 10 procedures, RCTs appear to only support the superiority of TKR for end stage osteoarthritis and carpal tunnel decompression for carpal tunnel syndrome over non-surgical care. But even for these, supporting evidence appears to be limited.
While the 10 procedures reviewed may benefit certain patient groups, there is a lack of research to determine who those patients are.
Reference: Blom AW, Donovan RL, Beswick AD, Whitehouse MR, Kunutsor SK. Common elective orthopaedic procedures and their clinical effectiveness: umbrella review of level 1 evidence. BMJ. 2021;374:n1511.
