"this study confirms that the majority of orthopaedic surgical interventions are not based on RCTs" - thoughts??

[Doc mu]

Randomised Trial Support for Orthopaedic Surgical Procedures

We investigated the proportion of orthopaedic procedures supported by evidence from randomised controlled trials comparing operative procedures to a non-operative alternative. Orthopaedic procedures conducted in 2009, 2010 and 2011 across three metropolitan teaching hospitals were identified...

journals.plos.org

This study comes to the conclusion that MANY of the most commonly performed orthopedic procedures are not based on high quality RCTs, what does this mean for the future of ortho? will we see less ortho surgeries in the future and a shift towards non-surgical managment? will the majority of the field's bread and butter go extinct like meniscectomy, vertebroplasty, arthroscopic knee debridment for arthritis...etc etc?

Would insurance companies refuse to pay for procedures without enough high quality RCTs backing them up?

Sorry for the doom and gloom but i wouldn't want to go into ortho only for the field to lose many of the cool operations that originally drew me to it

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[Vandalia]

Why would this have any impact whatsoever? The conclusion is true for most things in medicine, particularly for surgical procedures.

Do you really think a patient is going to participate in a RCT where he is randomized to receive no treatment for a compound fracture?

Keep in mind there is no RCT showing that parachutes are beneficial when jumping out of an aircraft.

 

[Doc mu]

Why would this have any impact whatsoever? The conclusion is true for most things in medicine, particularly for surgical procedures.

Do you really think a patient is going to participate in a RCT where he is randomized to receive no treatment for a compound fracture?

Keep in mind there is no RCT showing that parachutes are beneficial when jumping out of an aircraft.

But then how do we know the procedures are beneficial? RCTs made us toss many procedures we thought were beneficial (since they made biomechanical and biological sense) out the bin, how can we be sure things like TKAs and THAs won't follow in the footsteps of meniscectomy?

I know that arthroscopic ACL reconstruction is currently on the chopping block where the most recent meta-analysis proved it is not better than conservative treatment...

 

[Vandalia]

But then how do we know the procedures are beneficial? RCTs made us toss many procedures we thought were beneficial (since they made biomechanical and biological sense) out the bin, how can we be sure things like TKAs and THAs won't follow in the footsteps of meniscectomy?

Well, the burden of proof is on those who would make the claim that TKA and THA or even ACL reconstruction are not beneficial.

There is no chance you would find anyone suffering from severe joint disease who would forgo TKA or THA or other similar procedures and enter a randomized trial. In addition, meta-analysis does not provide useful data for individual cases. Sure, in the 70 year old in a wheelchair repair probably does not provide any benefits. That is different from the man or woman who competes in multiple triathlons or marathons, or who is active in club soccer/softball/whatever.

Since it appears you are early in your medical career, this is the most important rule: Every case is different and EMB must be used with great caution in individual cases; since most studies look at very few parameters, wherever a specific patient provides a vast array of data points.

How do we know it works? Because there are happy patients in the end. That is all that matters. Never let science or statistics overshadow the point that medicine is primarily an art, not a science.

 

[DarkHorizon]

But then how do we know the procedures are beneficial? RCTs made us toss many procedures we thought were beneficial (since they made biomechanical and biological sense) out the bin, how can we be sure things like TKAs and THAs won't follow in the footsteps of meniscectomy?

I know that arthroscopic ACL reconstruction is currently on the chopping block where the most recent meta-analysis proved it is not better than conservative treatment...

I can assure you that TKA and THA are not going anywhere. THA and TKA are the two most successful surgeries respectively from patient satisfaction standpoint in all of medicine.

 

[Miles Gloriosus]

I can assure you that TKA and THA are not going anywhere. THA and TKA are the two most successful surgeries respectively from patient satisfaction standpoint in all of medicine.

I can assure you that TKA and THA are not going anywhere. THA and TKA are the two most successful surgeries respectively from patient satisfaction standpoint in all of medicine.

The operation of the century: total hip replacement - PubMed

In the 1960s, total hip replacement revolutionised management of elderly patients crippled with arthritis, with very good long-term results. Today, young patients present for hip-replacement surgery hoping to restore their quality of life, which typically includes physically demanding...

pubmed.ncbi.nlm.nih.gov

 

[militaryPHYS]

I know that arthroscopic ACL reconstruction is currently on the chopping block where the most recent meta-analysis proved it is not better than conservative treatment...

What study are you referring to?

 

[Doc mu]

What study are you referring to?

I can no longer find it, it was a study assessing current literature on ACL recon that concluded that we do not have enough evidence on ACL recon benefit or whether or not it should be favored over simple physical therapy, something along those lines...

 

[DarkHorizon]

I can no longer find it, it was a study assessing current literature on ACL recon that concluded that we do not have enough evidence on ACL recon benefit or whether or not it should be favored over simple physical therapy, something along those lines...

Likely for sedentary patients over 35. Patient cohort is important. Also ACL deficient arthropathy is real, although data is split on it.