In general, most common orthopaedic procedures are done for soft tissue pathology (joint, tendon, and nerves). In the UK alone, 25% of all surgeries performed in the NHS are related to musculoskeletal problems. Surgery is considered in cases that fail simple measures and exercise. Which procedures are effective and which are not?

Most common orthopaedic procedures

We have listed the most common orthopaedic procedures for soft tissue injuries.

Carpal tunnel release surgery

man holding his painful wrist needs a carpal tunnel injection

Pressure on the median nerve in the carpal tunnel of the wrist causes pain, numbness, and paraesthesia in the hand. Therefore, a surgical release is recommended in cases that fail simple treatments such as injections, splints, and rehab. In general, carpal tunnel release surgery improves symptoms better than simple treatments but with more side effects. Also, open vs. endoscopic carpal tunnel surgery found no difference in effect or side effects.

Arthroscopic partial meniscectomy

Surgeons perform arthroscopic partial meniscectomy for pain and swelling associated with a torn meniscus. Overall, partial meniscectomy did not show benefits compared to conservative treatment. However, in people with no underlying arthritis, keyhole surgery provided a small benefit. Generally, partial meniscectomy was compared to an exercise program for 8-12 weeks.

What about meniscal repair vs. meniscectomy?

Overall, a few high-level studies comparing meniscal repair vs. meniscectomy show that meniscal repair is better. But, there is only a little evidence comparing a meniscal repair to non-surgical treatment such as physiotherapy.

ACL reconstruction surgery

ACL reconstruction

Generally, ACL surgery is performed after a tear of the anterior cruciate ligament. Surgeons perform ACL reconstruction surgery by taking a tendon graft from the hamstring or patellar tendon and placing the graft inside to replicate a normal ACL.

Interestingly, high levels studies found no difference between the reconstruction and rehab groups. In one study comparing torn ACL surgery options, only 50% of the rehab group needed to have surgery eventually. Also, return to sport after ACL reconstruction only occurs in 55% of amateur athletes compared to 85% of elite athletes.

The bottom line regarding ACL reconstruction: it is not always successful. Rehab is essential after the procedure and will increase success. Overall, it would help if you spoke to your doctor about the pros and cons of reconstruction depending on your circumstance and desired activity.

Shoulder decompression surgery

Often, we treat shoulder tendon injuries or shoulder bursitis with exercise plus one or two cortisone injections. In complex cases, people have subacromial decompression surgery.

Overall, a summary of high-level studies suggests shoulder decompression surgery is no better than physiotherapy or sham surgery.

Spinal fusion surgery

Surgeons perform spinal fusion surgery for complex cases of spine degeneration.

Overall, comparing spinal fusion to alternative spinal fusion (exercise) suggests no difference in success or return to work between groups. However, there were a lot more complications in the spinal fusion group.

Total knee replacement surgery for knee arthritis

Knee arthritis leads to the wearing away of the cartilage in the knee. We treat most cases with exercise therapy and other injections. However, in complex issues, surgeons offer total knee replacement surgery.

In the only study comparing total knee replacement surgery to exercise therapy, the surgery produced a more significant improvement in pain and function at 12 months. However, there is a 16% complication rate compared to only 2% in the exercise group.

Total hip replacement surgery for hip arthritis

Hip arthritis leads to hip or groin pain. In simple cases, we recommend exercise therapy and injections. In complex issues, we consider total hip replacement surgery to replace the hip joint.

Somewhat surprisingly, higher-level studies for hip arthritis are few and far between. But, overall, we think total hip replacements are a good alternative if you’re struggling with hip or groin pain due to hip arthritis.

Final word from Sportdoctorlondon on most common orthopaedic procedures

So, in summary, surgery for soft tissue conditions reveals differing effectiveness.

The most substantial evidence is for carpal tunnel release and total knee joint replacement.

There is insufficient evidence for meniscal repair.

Finally, there is no evidence for partial meniscectomy keyhole surgery, shoulder decompression surgery, or spinal fusion.

Overall, in most cases, you need an accurate diagnosis. Generally, you should try non-surgical treatment first, irrespective of the problem. However, if you’re thinking about surgery, you should speak to a qualified doctor about whether surgery is for you.

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