No strong, high-quality evidence shows that many commonly performed elective orthopedic procedures are more effective than nonoperative alternatives, according to the results of an umbrella review published online in The BMJ.
Ashley W. Blom, MD, PhD, from the University of Bristol in the United Kingdom, and colleagues conducted a literature review to compare the clinical effectiveness of the 10 most common elective orthopedic procedures (arthroscopic anterior cruciate ligament reconstruction, arthroscopic meniscal repair of the knee, arthroscopic partial meniscectomy of the knee, arthroscopic rotator cuff repair, arthroscopic subacromial decompression, carpal tunnel decompression, lumbar spine decompression, lumbar spine fusion, total hip replacement, and total knee replacement) versus no treatment, placebo, or nonoperative care.
The researchers found that randomized controlled trial evidence supports the superiority of carpal tunnel decompression and total knee replacement over nonoperative care. There were no randomized controlled trials identified that specifically compared total hip replacement or meniscal repair to nonoperative care. For the other six procedures, evidence showed no benefit over nonoperative care.
“Despite the lack of strong evidence, some of these procedures are still recommended by national guidelines in certain situations,” the authors write. “An urgent need exists to prioritize research into common elective orthopedic interventions compared with no treatment, placebo, and nonoperative treatment.”
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