Common elective orthopedic procedures may not be more effective than nonoperative care
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Published results showed many commonly performed elective orthopedic procedures do not have a strong, high-quality evidence base that shows these are more effective than nonoperative alternatives.
Searching Medline, Embase and the Cochrane Library from database inception until Sept. 2020, researchers performed an umbrella review of meta-analyses of randomized controlled trials that compared the clinical effectiveness of the 10 most common elective orthopedic procedures with no treatment, placebo or nonoperative care, and assessed the impact on guideline recommendations. In the absence of meta-analyses of randomized controlled trials, researchers used individual randomized controlled trials followed by systematic reviews or meta-analyses of observational cohort studies.
Researchers found no randomized controlled trials that compared total hip replacement and meniscal repair for acute tears with nonoperative care. Among the other eight procedures, results showed some evidence supported the superiority of total knee replacement and strongly supported carpal tunnel decompression over nonoperative treatment. However, randomized controlled trials showed nonoperative treatment had similar outcomes to arthroscopic ACL reconstruction, arthroscopic partial meniscectomy, arthroscopic repair for acute rotator cuff tears, arthroscopic subacromial decompression, lumbar spinal decompression for spinal canal stenosis and spinal fusion for degenerative disc disease, according to researchers.
“When randomized controlled trials have been conducted, they sometimes support observational evidence and expert opinion, but not universally so,” the authors wrote. “To optimize decision-making, surgeons should apprise themselves of the evidence, make decisions based on the highest-quality trials available and, in the absence of these, base their judgement on observational evidence, acknowledging that this may be imperfect. Simultaneously, surgeons and research-funding bodies should actively contribute to filling the key knowledge gaps by enabling and participating in well-constructed pragmatic randomized controlled trials.”
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