Orthopedic surgery (surgery for problems related to bones, joints, tendons and ligaments) is the third most common reason Australians go under the knife.
Last year, more than 100,000 orthopedic surgeries were performed in Australian public hospitals. Since most orthopedic surgeries are performed in private hospitals, the actual number is much higher (and sadly unknown).
But what most people don’t realize is that many common orthopedic surgeries are no better at reducing pain than cheaper and safer non-surgical alternatives, such as exercise programs. Some surgeries provide the same result as a placebo surgery, where the surgeon only performs an examination of the joints, rather than performing the actual surgery.
And contrary to popular opinion, placebos aren’t really very powerful, so you shouldn’t recommend real surgery that isn’t better than a placebo.
In this article, we discuss the evidence behind three commonly performed orthopedic surgeries for back, knee, and shoulder pain that could be doing patients (and their pocketbooks) more harm than good.
spinal fusion for back pain
Spinal fusion is the riskiest type of surgery for back pain and the most expensive orthopedic procedure performed in Australia. Depending on your health insurance arrangements, the total cost of the surgery can be around AUD58,000 and out-of-pocket costs can be around AUD10,000.
It involves permanently fusing two or more vertebrae together to keep them from moving with each other, usually by using metal and bone implants from other areas of the body.
It was originally intended to treat spinal bone fractures and some spinal deformities, such as severe scoliosis (abnormal curvature of the spine). Surgeons’ rationale for using this surgery has expanded over time and is now the most common surgery to treat everyday back pain that is not caused by a serious problem such as a fracture or infection.
This is despite evidence that spinal fusion is no more effective than non-surgical treatments (such as an exercise program) and often leads to complications. About one in six patients experiences a serious complication, such as an infection, blood clot, nerve injury, or heart failure. In New South Wales, only one in five workers who have a spinal fusion return to work after two years and one in five have another spinal surgery within two years.
Arthroscopy for knee and shoulder pain
Arthroscopy is a type of minimally invasive surgery that is commonly used to treat knee osteoarthritis and shoulder pain. Surgery is used to remove or repair damaged pieces of bone or cartilage that are thought to be causing pain.
Thousands of knee arthroscopies are performed each year. In 2013, more than 33,000 knee arthroscopies were performed in Australian hospitals. Since then, this number has dropped by around 40%.
Australian data shows that the number of shoulder arthroscopies increased by almost 50% between 2000 and 2009. Since then, the numbers have held steady, around 6,500 surgeries per year between 2009 and 2021.
The cost of these surgeries is substantial. Typical out-of-pocket costs for patients with private health insurance are A$400 and A$500 for knee and shoulder arthroscopy, respectively. Sometimes out-of-pocket expenses can be as high as A$1,900 to A$2,400, respectively.
High-quality research shows that arthroscopy to treat osteoarthritis, wear of the meniscus in the knee, and to remove inflamed and thickened bone and tissue in the shoulder is no better than placebo surgery.
Even though these surgeries are minimally invasive, they still result in substantial drawbacks. For example, it can take up to six weeks after shoulder arthroscopy for patients to do simple activities of daily living, such as reaching overhead or driving, and up to three months to return to heavy work or sports.
So what are the alternatives?
It is important to know what treatment options are available to you and their benefits, harms, and costs to ensure that you make the best decision for you. Fortunately, there are tools available to help you. We have developed decision aids to help people with shoulder pain decide whether or not to have surgery (the tool is available here).
Our research has shown that people with back pain who seek a second opinion can avoid unnecessary spinal surgery, including spinal fusion.
And avoid Dr. Google. Information on the Internet often overstates the benefits and understates the harms of common surgeries, such as spinal fusion, shoulder arthroscopy, and surgery for a torn anterior cruciate ligament (ACL). You will find misleading information even on websites from trusted sources, such as government and university websites.
Before making a decision, be sure to ask your doctor the following questions:
- Am I more likely to get better with surgery than without it?
- What happens if I choose not to have surgery?
- What are the risks of undergoing this surgery? Both during surgery (for example, anesthesia) and after surgery (for example, complications)
- Have I received enough information about the benefits and harms of having surgery compared to other treatments (including doing nothing)?
Surgery is sometimes recommended because nonsurgical treatment has not worked. Unfortunately, the failure of nonsurgical treatment does not make ineffective surgery more effective. Still not working other than not operating.
The available evidence tells us that the risks and drawbacks of the three surgeries discussed here outweigh the potential benefits.
Giovanni E Ferreira, NHMRC Emerging Leaders Researcher, University of Sydney; Ian Harris, Professor of Orthopedic Surgery, UNSW Sydney; Joshua Zadro, NHMRC Emerging Lead Researcher, University of Sydney, and Mary O’Keeffe, Postdoctoral Research Fellow, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.