When you are suffering from ongoing debilitating joint pain, surgery may seem like a quick, easy and permanent solution to make it all go away. But in reality, many orthopedic surgeries fall short of the mark, sometimes even doing more harm than good, thus delaying and prolonging the recovery process.
Moreover, may surgical procedures are quasi-experimental in nature, and have not been entirely vetted by an overseeing body for safety and efficacy. In fact, many surgical procedures are not backed up by solid or compelling research. Yet orthopedic surgeons routinely put patients with joint pain under the knife, because surgical treatment is what they know.
Knee Surgery
While surgical intervention may be justified in some cases of trauma such as sports injuries, where structural damage is beyond the body’s ability to repair on its own, the majority of knee surgeries are performed on non-athletic patients complaining of pain from osteoarthritis.
Three basis types of surgery are debridement, which removes damaged bone or cartilage; lavage, which irrigates the joint capsule with a saline solution tomy, which removes all or part of the meniscus.
However, compared to conservative non-surgical treatment methods, including exercise, physical therapy and weight loss, the benefits of surgery are negligible at best. Perceived results of surgery may even be in the patient’s imagination, as was revealed in a recent experiment.
A controlled study by Lubowitz (2002) sought to test the affect of knee surgery on patients’ perceptions of pain and function. The control group received a fake surgery with an incision only, while the study group received an actual surgical procedure. Over a two-year followup period, both groups reported similar outcomes at every followup stage.
Shoulder Surgery
As with knees, shoulder surgeries are most often performed on patients with degenerative conditions not related tola et al. (2013) found no long-term benefits of the procedure.
Spinal Surgery
Most non-traumatic low back pain is not linked to reduce contact with neural bodies.
However, a long-term followup of three randomized controlled studies of spinal fusion surgeries by Mannion et al. (2013) revealed that the surgeries offered no better outcomes for low back pain than conservative treatment.
Conservative Treatment vs Surgery
Surgery is an invasive and expensive treatment for joint pain that carries with it high risks for infection, nerve damage and other undesirable side effects including death. Non-traumatic degenerative joint conditions generally respond well to conservative treatment methods such as exercise, weight loss and physical therapy, offering more hope for favorable outcomes in the long run.
The joint pain specialists at NYDNR are dedicated to treat both traumatic and degenerative joint pain.
Resources
Lubowitz, James H. “A controlled trial of arthroscopic surgery for osteoarthritis of the knee.” Arthroscopy: the journal of arthroscopic & related surgery: official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 18.8 (2002): 950.
Ketola, S., et al. “No evidence of long-term benefits of arthroscopic acromioplasty in the treatment of shoulder impingement syndrome: five-year results of a randomised controlled trial.” Bone & joint research 2.7 (2013): 132-139.
Mannion, Anne F., Jens Ivar Brox, and Jeremy CT Fairbank. “Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials.” The spine journal 13.11 (2013): 1438-1448.
In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.
Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.
The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.
Dynamic ultrasonography examination demonstrating the full thickness tear and already occurring muscle atrophy due to misdiagnosis and not referring the patient to proper diagnostic workup
Demonstration of how very small muscle defect is made and revealed to be a complete tear with muscle contraction under diagnostic sonography (not possible with MRI)
Complete tear of rectus femoris with large hematoma (blood)
Separation of muscle ends due to tear elicited on dynamic sonography examination
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