Dr. Saam Morshed, a professor of orthopedic surgery at the University of California, San Francisco who was not involved in the study, said, “I think it’s fair that we hold up in the mirror and review the effectiveness of some of these surgeries. “. It is important to understand where we have gaps in our knowledge of the effectiveness or ineffectiveness of common surgical treatments. “
At the same time, he said, “It’s also important to understand that just because there isn’t a randomized trial to support a particular treatment, it doesn’t mean that the treatment is ineffective.” Hip surgery is a good example, he said. There may not be randomized trials of hip replacement surgery, but there are overwhelming observational results for its effectiveness when compared to non-surgical treatment.
The picture may differ for other common methods. Arthroscopic surgery to repair the anterior cruciate ligament (ACL) in the knee, one of the most common sports injuries in the United States, has a success rate of up to 97 percent in some studies. But when the surgery was compared to nonsurgical treatments, the review found that there was little difference in pain scores or the need for further surgical or nonsurgical treatment.
The researchers describe a broad survey of studies of surgery to repair the rotator cuff, the group of tendons and muscles that hold the humerus in the shoulder socket. When compared to exercise and steroid injections, the review showed that there was little or no clinically significant difference in pain, function, quality of life, or patient satisfaction with the results.
Some studies were randomized controlled trials in which one group of patients received real surgery and a corresponding group received placebo surgery. In two of these studies of shoulder impingement surgery, a condition that causes pain when the arm is raised, there was no difference between surgery and placebo surgery in terms of patient-reported results or side effects.