Do Orthopedic Surgeries Really Work? Reality vs Perception

Do-Orthopedic-Surgeries-Really-Work

When you are suffering from ongoing debilitating joint pain, surgery may seem like a quick, easy and permanent solution that will make it all go away. But the truth is that many orthopedic surgeries fall short of the mark, sometimes doing more harm than good, and often delaying the recovery process for patients seeking to resolve their pain and restore function.

Moreover, many surgical procedures are quasi-experimental in nature, not having been vetted by any overseeing body for safety and efficacy, as is always the case for emergent pharmaceuticals. In fact, for many surgical procedures, there is a dearth of research to support their efficacy or justify their practice. Yet orthopedic surgeons routinely put patients with complaints of joint pain under the knife.

Knee Surgery

While knee surgery may be justified in cases of trauma, as from sports, where structural damage exceeds the body’s ability to repair itself, most cases of knee surgery are performed on patients reporting pain from degenerative joint disease such as osteoarthritis.

There are fundamentally three types of knee surgery that are most commonly performed in degenerative knee patients:

  • Debridement: Removal of damaged cartilage and/or bone
  • Lavage: Irrigation of the joint capsule with saline solution to remove cartilage fragments
  • Arthroscopic partial meniscectomy: Removal of some or all of a meniscus in the knee joint

However, the efficacy of all three procedures is negligible when compared to conservative treatment such as exercise, weight loss and physical therapy.

To test the effectiveness of knee surgery on patients’ perception of pain and function, a controlled study was conducted by Lubowitz (2002) that compared a control group who received a fake surgery (incision only) to a group who received a real procedure. Over a two-year followup period, the control group reported outcomes similar to those of the surgical group at all points in time.

Shoulder Surgery

As in the case with knees, shoulder surgeries are most often performed on patients with degenerative joint conditions that are not related to trauma. The rotator cuff in particular is pinpointed as a cause of pain and dysfunction, and surgery is frequently aimed at the acromion process which sometimes impinges the rotator cuff, in a procedure acromioplasty, where a portion of the acromion is removed. Yet a five-year controlled study conducted by Ketola, et al. (2013) found no evidence of long-term benefits of shoulder surgeries to treat shoulder impingement syndrome.

Spinal Surgery

Most non-traumatic low back pain is non-specific in nature, meaning it is not linked to any structural deformation of the spine. Nevertheless, spinal surgeries are performed routinely on patients complaining of low back pain, the most common being fusion of the vertebrae to lessen contact with neural bodies that causes pain.

However, a long-term follow-up of three randomized controlled trials by Mannion et al. (2013) found spinal fusion surgeries to offer no better outcomes than conservative treatment for patients suffering low back pain.

Surgery vs Conservative Treatment

Surgery is an expensive and invasive approach to treatment for joint pain that carries with it high risks for infection, neural damage and other undesirable side effects. When dealing with degenerative joint conditions not caused by trauma, it is safe to say that conservative treatments including exercise, weight loss and physical therapy offer more hope for favorable health outcomes in the long run, as they address more than just localized joint pain.

The joint pain specialists at NYDNRehab are dedicated to getting to the source of your pain and finding long-term solutions that restore function. We use the latest technologies and treatments proven effective for musculoskeletal conditions, both traumatic and degenerative. Contact NYDNRehab today and see why we are the very best rehabilitation clinic in NYC for the treatment of chronic joint pain.

Resources

Lubowitz, James H. 2002. “A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee.” Arthroscopy 18 (8): 950–51. http://www.ncbi.nlm.nih.gov/pubmed/12368798.

Ketola, S et al., 2013. “No Evidence of Long-Term Benefits of Arthroscopicacromioplasty in the Treatment of Shoulder Impingement Syndrome: Five-Year Results of a Randomised Controlled Trial.” Bone and Joint Research 2 (7): 132–39. doi:10.1302/2046-3758.27.2000163.

Mannion, AF et al., 2013.“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): 1438–48. doi:10.1016/j.spinee.2013.06.101.

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