The most common joint procedures are not backed by high quality testing

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The most common (orthopedic) bone and joint procedures, such as hip replacements and shoulder repair surgery, are not backed by high-quality testing, mainly due to the lack of definitive tests, an analysis suggests. of data published by The BMJ today.

Although, despite the lack of conclusive evidence, some of the procedures are still recommended by national guidelines in certain situations, according to the findings.

Musculoskeletal disorders affect approximately 1 in 4 adults in the UK and account for more than 25% of all NHS surgeries at a cost of £ 4.75 billion each year.

National we recommend several interventions, but there are many concerns they have no readily available or high-quality evidence on its clinical efficacy to support its use.

To delve deeper into this, a team of researchers from the UK used data from previous analyzes of and other studies to compare the clinical efficacy of the 10 most common orthopedic procedures without treatment, placebo, or nonoperative care.

They then compared the results of each procedure with national guidelines to see if the recommendations reflected the set of evidence available.

Procedures included knee cartilage (meniscal) repair, shoulder rotator cuff repair, carpal tunnel decompression surgery, and total hip and knee replacements.

The researchers found controlled randomized trials that supported the superiority of carpal tunnel decompression and on non-operational care.

However, there is no random control total hip replacement or meniscal repair was specifically compared with nonoperative care. And evidence from the other six procedures showed no benefit with respect to nonoperative care.

They also found that while seven of the procedures have been recommended for use under national guidelines, there is no high-quality evidence to definitively support these recommendations for most of them.

They say this is mainly due to the lack of randomized controlled trials comparing the procedure with nonoperative care.

They emphasize that this lack of evidence from the trial does not mean that the interventions are ineffective, but without evidence from randomized controlled trials, it is extremely difficult to determine the true effect of treatment.

This review has some limitations that may have influenced the results, such as including different variable quality study designs. But the researchers point out that this is a comprehensive analysis of known databases and guidelines and that the recommendations can be applied to other healthcare settings.

As such, they say there is an urgent need to prioritize research, especially for procedures with a limited evidence base, and definitive randomized controlled trial designs to evaluate its clinical efficacy.

“This will improve , reduce healthcare costs, enable more efficient use of our resources and increase social confidence in orthopedic interventions, ”they write.

In addition, his findings support the view that with 10 million patients in England pending surgery, “now is the perfect time to invest in large-platform trials.”


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More information:
Common elective orthopedic procedures and their clinical efficacy: general review of level 1 tests, BMJ (2021). DOI: 10.1136 / bmj.n1511

Citation: The most common joint procedures not backed by high quality testing (2021, July 7) retrieved July 7, 2021 at https://medicalxpress.com/news/2021-07-common-joint-procedures-high -quality.html

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