Guest Blog by: Todd E. Riddle, DC, CCSP, RKT, CSCS
This may come as a surprise to musculoskeletal clinicians out there, but many orthopedic surgeries aren’t all that it is sliced up to be. To some merely uttering these words is an act of heresy, deserving swift and severe punishment on the altar that medicine has built. To others, this comes as a confirmation of something they already observed. Too many surgeries have little or no evidence to support them.
I recently just finished up a fascinating book written by orthopedic surgeon, Ian Harris, titled "Surgery, The Ultimate Placebo." Aside from the fact he wrote from a place of vast experience, he brought the evidence to the table.
“It is estimated that in 2006 there were seventy-five randomized trials published in the medical literature every day, and there are now over 20 million medical articles published, yet there have only ever been a handful of published placebo (sham) studies involving surgery.”
Even more concerning, as evidenced in the article below, is that studies that do make it to publication about these procedures were poorly designed and had a high risk of bias.
Here is a short list of just a few procedures that are currently under significant scrutiny:
- Arthroscopic meniscectomy for degenerative meniscal tears.
- Labral repair nor biceps tenodesis for SLAP II lesions.
- Vertebroplasty for osteoporotic compression fractures.
- Open debridement for tennis elbow.
- Knee arthroscopy for arthritis
- Spinal Fusion
- Subacromial Decompression
A recent meta-analysis published in the British Journal of Sports Medicine, explored the efficacy of subacromial decompressions surgery for subacromial pain syndrome. Keep in mind, this analysis came to the same conclusion as multiple papers before it.
“Subacromial decompression surgery for SAPS provided no important benefit compared with placebo surgery or exercise therapy and is probably associated with a risk of serious harms.”
Click here to read the BJSM Paper >>
To be clear, it’s not time to throw the baby out with the bath water. Surgery has its place, especially ones that have been submitted to blinded, sham/placebo trials. In fact, this comes as great new for those of us in the rehabilitation world. This simply means we need to keep pressing forward with patient-centered, evidence-informed care and not be so hasty to refer complicated musculoskeletal patients off to surgery. Is this an easy task? Not in the least. But you are one of the only things standing between your patient and potentially needless, and harmful, surgeries.
Dr. Todd Riddle is a Certified Chiropractic Sports Practitioner (CCSP), Registered Kinesiotherapist (RKT) a Certified Strength and Conditioning Specialist (CSCS) with 20 years of experience in sports medicine and sports performance training. Dr. Riddle has treated and worked with thousands of athletes across many sports, ranging from the amateur to professional. Most recently, he was the team chiropractor and member of the sports medicine team for the historic Nigerian Bobsled and Skeleton Federation at the 2018 Olympic Winter Games in Pyeongchang, South Korea.
In addition to his private practice, Dr. Riddle has significant experience in higher education, teaching physical rehabilitation, diagnosis and case management as an assistant professor in the United States. He is also an international speaker on sports medicine and physical rehabilitation.