Common elective orthopaedic procedures and their clinical effectiveness: umbrella review of level 1 evidence

Blom AW, Donovan RL, Beswick AD, Whitehouse MR, Kunutsor SK · BMJ

Randomised evidence supported carpal tunnel decompression and total knee replacement over non-operative care. For six of the ten, including arthroscopic partial meniscectomy, the trial evidence showed no benefit over non-operative care. For two — total hip replacement and arthroscopic meniscal repair — no randomised trial against non-operative care exists at all. The review also compared each verdict against what national clinical guidelines recommend.

Population

Ten of the most common elective orthopaedic procedures, including arthroscopic partial meniscectomy and arthroscopic meniscal repair, assessed through meta-analyses of randomised trials where these exist

Intervention

Each procedure as performed in routine practice

Comparator

No treatment, placebo, or non-operative care

Limitations

An appraisal of existing meta-analyses rather than of patients, so where the underlying evidence is thin the verdict is about the evidence rather than about the operation — which is the explicit finding for two of the ten procedures. Quality of each meta-analysis was rated with AMSTAR and the best evidence selected by the Jadad algorithm, both of which involve judgement. Supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston and the University of Bristol; two authors declare research grants, lecturing fees and textbook royalties outside this work.