Recently I came across an article on Doximity, a networking site for healthcare professionals, that suggested a couple of orthopedic surgery operations may be doing patients and their pocketbooks more harm than good. Reading through the article, I was astonished by how much it misled with half-truths, and I bookmarked the piece so that I could come back and pen a blog on the subject when I had some free time.
Today, when I went to find the same article, I noticed it was no longer available on the site. Had it been removed because of professional outcry? Whatever the reason for its disappearance, I found another site that published a similar piece on how spinal fusion and knee/shoulder arthroscopy surgeries may be doing more harm than good. Below, I share my thoughts on those claims.
Spinal Fusion Surgery
While none of these procedures are commonly recommended in my office as I specialize in troubles below the knee, the data cited and recommendations for and against are so poorly presented that they will cause massive confusion for patients. It is almost as if they are claiming that surgeons do things without evidence to support. In the article, they state that surgeons oftentimes move forward with spinal fusion procedures “despite evidence that spinal fusion is not more effective than non-surgical treatments (such as an exercise program) and often results in complications.”
For the treatment of back pain, it is clear that non-surgical management is extraordinarily successful. But when non-surgical management fails and there are distinct painful conditions that correspond to both X-ray, MRI and even discogram, surgery can be highly successful and relieving. Can you imagine showing this article to a patient who has spent the last six months trying physical therapy, has significant signs of lumbar spine instability on flexion and extension radiographs, whose MRI shows significant end plate edema and has a positive discogram which correlates to the site of arthritis in the back?
Surgeons don’t just move forward with a procedure for anyone who walks in their door. Specific conditions need to be met, and months of conservative care will be pursued first because surgeons know if they can fix the problem without an operation, that is what’s best for the patient. To suggest otherwise is a disservice to patients and providers.
Next, they suggest that shoulder arthroscopy to debride inflamed or thickened bone and that knee arthroscopy for knee osteoarthritis is no better than placebo. We know that shoulder arthroscopy is performed to treat rotator cuff tears and shoulder instability, and these clear mechanical conditions can significantly benefit from an arthroscopic procedure. As for knee arthroscopy, it has been shown to successfully treat conditions such as meniscus tears with mechanical symptoms with incredible results. Again, for the right patient who has failed to find relief with conservative care, an arthroscopic procedure can get them back to the activities they love.
To suggest that these operations are harmful to the patient and a money grab by doctors is doing a huge disservice to the industry. Again, we can’t just paint with broad brushstrokes and fit one narrative to every single patient. It’s absolutely true that conservative measures like physical therapy, posture changes, weight loss, dietary changes, controlled exercise, medications and stretching routines can yield great results, but that doesn’t mean everyone will experience this type of recovery, and for these patients and those with a more severe injury, we may need to consider these surgeries that do in fact have a high rate of success for the right type of patient. Not all meniscus tears need surgery, but when specific issues are present, it can be the perfect solution if non-operative treatment fails.
It’s ironic that the article finishes by saying be wary of misinformation, because that’s exactly what they are spreading by grouping all patients with a specific condition into one category. To suggest that the right patient should not consider these procedures is borderline unethical.
