Surgery can be an effective option to fix painful hips, shoulders, and other joints – but non-surgical treatments can be just as effective for certain conditions, according to a 2021 study published in one of the world’s oldest medical journals, the BMJ. The researchers conducted an “umbrella review,” meaning they collected and critically evaluated numerous studies for 10 of the most common orthopedic operations.
Outcomes for surgery vs non-surgical interventions were available for eight orthopedic conditions. The evidence pointed to surgery offering better outcomes for carpal tunnel syndrome and total knee replacement, while six other orthopedic operations fared no better than treatment with physical therapy, drugs, exercise, and weight management. No conclusion was reached on total hip replacement and meniscal repair of knee tears because no studies were found that directly compared surgery to non-surgical intervention.
The greatest weight was given to research that used randomized control trials to compare outcomes of specific surgeries with non-surgical interventions. Long considered a gold standard in research, a randomized control trial is conducted without identifying which group received which treatment. In this case, researchers were able to focus on outcomes rather than the specific procedure employed.
Consider non-surgical alternatives for these surgeries
For the following orthopedic operations, randomized clinical trials found no significant differences between the surgical operation or non-surgical treatments, as measured by a number of scientific evaluation tools and patient input.
Arthroscopic Anterior cruciate ligament – ACL – reconstruction. A major ligament in the knee, ACL injuries commonly occur from playing sports where sudden stops and changes in direction can cause a tear. Surgical reconstruction involves removing the torn ligament and replacing it with tissue from another part of the body or a deceased donor. Non-surgical intervention focuses on stabilizing and strengthening the ACL. In three studies, patients who had either ACL surgery or non-surgical interventions reported no differences in outcomes.
Arthroscopic partial meniscectomy. In a partial meniscectomy, fragments or frayed edges from a tear of the knee’s meniscus are surgically removed and the edges are smoothed so no frayed ends remain. The meniscus may tear as a result of injury or from wear and tear on the knee. People with osteoarthritis may be especially susceptible to a worn meniscus. One study compared a 12-week supervised exercise program with arthroscopic partial meniscectomy among 140 middle aged patients with degenerative tears. There was no clinically relevant difference in outcomes.
Arthroscopic rotator cuff repair. A group of tendons and muscles in the shoulder, the rotator cuff helps you lift and rotate your arm and keep your shoulder in place. Injury or wear and tear to the rotator cuff can cause severe shoulder pain. Repetitive motions are often the culprit, inflaming and irritating areas of the rotator cuff, causing conditions such as tendinitis and bursitis. In both short- and long-term follow-up, two randomized control trials found no important differences between the arthroscopic operation and physical therapy.
Arthroscopic subacromial decompression. Pain can result when rotator cuff tendons are squeezed or pinched between other structures in the shoulder area. Osteoarthritis or bone spurs may cause or contribute to this type of problem. The goal is to reduce the pressure and restore pain-free function of the shoulder. Three studies published in 2019 and 2020 found no difference in pain, function, or quality of life between surgery or non-surgical interventions.
Lumbar spine decompression. When the spaces between the vertebrae of the spine become compressed, a condition called stenosis may bring on lower back pain. Accidents or age-related changes may cause stenosis, and other symptoms can include numbness, tingling and weakness in arms and legs. Steroid drug injections, electrical stimulation, or gentle stretching of the spine through physical therapy are examples of non-surgical approaches to this problem. Surgery commonly involves removing bone to give more space and relieve the compression. In a study comparing surgery with anti-inflammatory drugs and physical therapy, both groups showed improvement in walking ability.
Lumbar spine fusion is surgery to join together any number of spinal cord vertebrae. The fusion can prevent excessive motion between vertebrae, which may be a source of back pain. It also can correct deformities, such as a sideways curvature of the spine. Non-surgical approaches to the pain lumbar spine fusion is meant to address can include physical therapy, patient education, exercise, pain relief by acupuncture and injections. In two studies, patients responding to the Oswestry Disability questionnaire scored the same whether they had lumbar spine fusion or non-surgical management.
Get all the information before you choose a treatment option
Depending on the specific type of injury or pain you’re experiencing, a doctor will suggest treatment options. If considering surgery, a doctor should advise you of success rates for the particular procedure; recovery time; and inform you of potential complications such as infection risk, injury to nerves, and blood clotting. Non-surgical procedures carry far fewer complications, so going that route, if at all possible, makes sense. Going about daily living pain-free is the ultimate goal, so don’t hesitate to ask questions or even request a second opinion. Gather all the information and choose wisely.
