Bone and joint surgery may be no more useful than medication

Bone and joint surgery may be no more useful than medication

July 8, 2021

Bone and joint surgery may be no more useful than physiotherapy or medication, new study suggests

  • Common joint operations may be no more effective than physiotherapy or drugs
  • A study found the benefits of surgery were not backed up by quality evidence
  • It included commonly performed surgery like hip replacements and knee repair

Common bone and joint operations may be no more effective than physiotherapy or treatment with drugs, a study suggests.

It found the benefits of some of the most frequently 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 drugs.

Researchers found the benefits of some of the most frequently performed surgery – such as hip replacements and knee repair – weren’t backed up by high-quality evidence (stock image)

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.

For six other procedures including shoulder rotator cuff repair and lumbar spine decompression, trials found no benefit of surgery over non-operative care, according to the review published in the British Medical Journal.

… and back pain drugs ‘ineffective’ 

Muscle relaxants commonly prescribed to treat lower back pain provide no effective relief, a study suggests.

They can reduce short-term discomfort but the effect is too small to be meaningful, says Neuroscience Research Australia, which reviewed 31 previous studies.

Last year in England more than 1.3 million prescriptions were issued for muscle relaxants including non-benzodiazepine antispasmodics and antispastics.

The study, published in the British Medical Journal, found no disability reduction after two weeks of use and no reduction in pain or disability at weeks three to 13.

The authors say patients should be told about their findings and the risk of side-effects including dizziness and nausea. 

While seven of the procedures have been recommended for use by national guidelines, there is not a high-quality body of evidence to ‘definitively’ support most of them, it concludes.

Around one million patients have surgery for musculoskeletal conditions on the NHS each year, official figures show.

A lack of evidence does not mean the interventions are ineffective but it makes it difficult to identify the ‘true treatment effect’.

Study leader Professor Ashley Blom, an orthopaedic surgeon, said: ‘An urgent need exists to prioritise research. The observation that most commonly used and recommended orthopaedic procedures had a limited and low-quality evidence base relating to their effectiveness is concerning.’

He added: ‘Interventions may work even if the evidence base has not yet been established or the observational evidence may be so overwhelming that trials would be deemed unethical or redundant. Hip replacement may be an example of this.’

Dr Benjamin Ellis, of the charity Versus Arthritis, said: ‘There should be no place in the NHS for operations that don’t work.

‘But 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: ‘This study has taken a narrow view of the evidence available for orthopaedic operations.

‘In particular, total hip replacement… is one of the most successful and cost effective of all operations, not just in orthopaedics.’

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