A recent study published in the British Medical Journal suggested that some elective orthopedic surgeries may be unnecessary, but the findings are being met with some push back from doctors all around the world.
In conclusion of their review of 10 common orthopedic surgeries, researchers wrote:
“Although they may be effective overall or in certain subgroups, no strong, high quality evidence base shows that many commonly performed elective orthopaedic procedures are more effective than non-operative alternatives. Despite the lack of strong evidence, some of these procedures are still recommended by national guidelines in certain situations.”
Not surprisingly, we came across this study because we listened to an interview with an orthopedic surgeon who was talking about some of the generalizations made by the study. You can read or listen to that here.
Dr. Silverman Weighs In
When talking about treating a patient and providing them with optimal care, it’s important that we really understand what it means to take a conservative approach. Conservative is oftentimes used interchangeably with non-surgical, but it shouldn’t be. Conservative should be viewed as the protocol that is most likely to lead to resolution of a problem with the lowest risk.
For example, bunions do not get better with physical therapy. They also do not get better with orthotic inserts. These treatments can sometimes helps to mitigate symptoms, but they do not correct the underlying issue. Therefore, corrective surgery to address a bunion should be considered the conservative route, since providing anything other than surgery would not actually fix the problem. Minimally invasive bunion surgery is the protocol that is most likely to lead to a resolution of symptoms with the lowest risk to the patient.
Things get more complicated when we look at other health conditions. For example, posterior tibial tendon tears have a well defined natural history. Without surgery, the foot slowly flattens and proceeds through stages of pain, pain with a flexible flatfoot deformity, pain with a stiff flatfoot deformity and finally to pain with a stiff flatfoot deformity and ankle arthritis. So what truly is the most conservative treatment? Should you watch it slowly deform and become dysfunctional, or should you surgically fix it?
With that said, there absolutely are conditions that can be delayed months, years or even decades, but this delay can still have functional consequences. Ankle instability, for example, can be managed with physical therapy, but without surgery you’re at a heightened risk for things like peroneal tendon tearing and ankle arthritis. We’ve even documented how star athletes who put off ankle ligament surgery puts other areas of their body under more stress and at risk for additional complications.
While not my specialty, I have plenty of experience with hip and knee arthritis as an orthopedic specialist for more than 20 years. To say that many of the most common orthopedic elective surgeries are not much more effective than non-operative techniques may overlook the fact that the total underlying issue remains unresolved when surgery is not pursued, and that can have functional consequences down the road.
In any regard, the point of the study and the conversation around it is that you need to have a conversation with your specialist about your condition, your treatment options and the likely outcomes should you pursue different routes. Nobody should feel pressured into an elective surgery, but at the same time, mildly quelling symptoms while the condition gets worse with non-operative treatment isn’t the conservative option either, so be informed, ask questions and come to a decision that is in the best interest of your long-term health.
For more information, or for help with your foot or ankle issue, reach out to Dr. Silverman’s office today.
