Last year, a (much disputed) paper generated headlines by suggesting there was a lack of evidence for some orthopaedic surgery. Now, a new paper suggests quite the contrary.

Last summer, professor of orthopaedic surgery Ashley Blom and his colleagues published a paper in the BMJ which concluded that: “no strong, high quality evidence base shows that many commonly performed elective orthopaedic procedures are more effective than non-operative alternatives.” He added that, “Despite the lack of strong evidence, some of these procedures are still recommended by national guidelines in certain situations.”

Amongst the orthopaedics community, it was a little like lighting the blue touch paper. Professor John Skinner, orthopaedic hip surgeon and vice president of the BOA announced that the findings “defied logic.”

Yorkshire Knee Clinic’s knee surgeons agreed with the BOA. we wrote a response to the paper saying so. Professor Blom reached his conclusion based on a lack of randomised data as to the benefits of hip and knee replacement. But as Professor Skinner was quick to note, randomised control trials (RCTs) have no place when the benefits of a course of action are self-evident. It was, he said, like carrying out a randomised trial “to see if wearing parachutes is better than not wearing parachutes when jumping out of an aeroplane.”

As we’ve seen in other walks of life, however, one expert voice dissenting from the conventional wisdom, no matter how flawed the view, is more than enough to cast doubt and unsettle patients, especially when those views are picked up by the mainstream media.

So it’s good to see a new paper by Benjamin Bloch and others redressing the balance. It collates data from randomized control trials that do exist for three different orthopaedic operations – total knee replacements (TKA), total hip replacements (THA) and ACL reconstructions (ACLR). In total, it encapsulates more than 1,000 trials involving move than 100,000 patients.

It finds that “TKA, THA, and ACLR are successful and durable operations that have helped millions of patients worldwide. The evidence from published RCTs indicates that for the vast majority of patients, standard conventional techniques in TKA and THA lead to satisfactory outcomes.”

As a direct riposte to Professor Blom’s paper, it concludes: “Although a recent review has highlighted a lack of RCTs comparing surgery with conservative/placebo treatments in orthopaedics, it is clear that a lack of such trials does not equate to a concern that these procedures lack effectiveness. Our series demonstrate that patients continue to benefit from these surgical interventions worldwide.”

So is orthopaedic surgery effective? Yes it is. And we have a lot of evidence to support it.

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