New medical research heavily criticises arthroscopic shoulder surgery.

 

This new study has left medical professionals in a position where they will need to reconsider patient referrals related to shoulder arthroscopies.

Image: Shoulder Arthroscopy.

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This  issue affects surgeons all over Australia, unfortunately performing arthroscopies can be their main line of work, their bread and butter. But does it help the patient?

The answer in many cases is, NO.

Just recently, a new study has been published by the Lancet. This study has observed multiple centres, utilising randomised,  placebo-controlled trials. There were 32 hospitals participating with a total of 51 surgeons. The study took on participants who had shoulder pain (subacromial) for at least 3 months.[1]

At 6 months, data for the Oxford Shoulder Score were available for 90 patients assigned to decompression, 94 to arthroscopy, and 90 to no treatment. Mean improvements via questionnaires did not differ between the two surgical groups at 6 months. However, both of the surgery groups presented greater improvements as opposed to the no treatment group. The conclusion for this study indicated any improvements may have been due to either placebo, or the efforts patients placed in post-operative physiotherapy.[1]

These findings question the value of this operation.This should be communicated to patients during the treatment decision-making process. [1]

Now, orthopaedic surgeons need to deal with the struggle of justifying such an expensive procedure. Incidentally, this is not the first time this sort of publication has been published. Just recently, we posted a blog entry about the cost benefit analysis of joint arthroscopies. The publication can be found here.

 

This study revealed, there is no financial justification for arthroscopic surgeries to continue.

 

As stated by Dr. J. Coleman “many orthopods are already adapting, and knee arthroscopy rates are waning. Though, last weekend’s Australian Financial Review indicated that the Australian Orthopaedic Association is in no mood to encourage the decline.”

Contrary to the comment above, the Australian Rheumatology Association officially recommended against arthroscopies for osteoarthritis.

 

Our take on this situation?

Medicine is constantly changing, it is time for our governing bodies to start adapting. We need this to happen sooner, rather than later.

 

REF [1]:Beard, D., Rees, J., Cook, J., Rombach, I., Cooper, C., Merritt, N., Shirkey, B., Donovan, J., Gwilym, S., Savulescu, J., Moser, J., Gray, A., Jepson, M., Tracey, I., Judge, A., Wartolowska, K., Carr, A., Ahrens, P., Baldwick, C., Brinsden, M., Brownlow, H., Burton, D., Butt, M., Carr, A., Charalambous, C., Conboy, V., Dennell, L., Donaldson, O., Drew, S., Dwyer, A., Gidden, D., Hallam, P., Kalogrianitis, S., Kelly, C., Kulkarni, R., Matthews, T., McBirnie, J., Patel, V., Peach, C., Roberts, C., Robinson, D., Rosell, P., Rossouw, D., Senior, C., Singh, B., Sjolin, S., Taylor, G., Venkateswaran, B. and Woods, D. (2017). Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. The Lancet.

 

Tags: Macquarie Stem Cells, Dr. Bright, Osteoarthritis Treatment, Dr. Ralph Bright, Stem Cell Therapy, Stem Cell Treatment, Stem Cells for Arthritis, Joint Arthoscopies, Arthroscopy failure