Do I Need Orthopaedic Surgery

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10 July 2019

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An increasing number of Australians are going under the knife for orthopaedic conditions, but is this helping or hindering their problems? Read on to find out whether surgery is necessary and what other options are available.

The number of surgeries carried out for orthopaedic conditions, including knee injuries, back pain and osteoarthritis of the hip, is increasing at an alarming rate. When it comes to knee surgery for tears of the anterior cruciate ligament (ACL), a 2018 report in the Medical Journal of Australia found, between 2000 and 2015, the annual incidence of surgery increased by 43 percent, and by 74 percent in people under the age of 25. 

Sports medicine physician, New Zealand Warriors rugby league team doctor and member of the Best Doctors network of global specialists, Dr John Mayhew believes that not just ACL procedures but orthopaedic surgery in general, is often unnecessary. “The decision for surgery should be based on a patient’s symptoms, not strictly on the findings from an X-ray or MRI,” he says.

Dr Mayhew isn’t the only one with this viewpoint. The Australian Rheumatology Association suggests arthroscopic knee surgery for osteoarthritis (OA) can make a patient worse than before surgery, and the British Journal of Sports Medicine published findings that knee arthroscopy was no better than exercise for those with degenerative knee arthritis. One prominent Australian orthopaedic surgeon believes almost half of all orthopaedic surgeries don’t offer any benefits that non-surgical treatments can’t deliver.


Orthopedic info graphic 
Why the increase in surgery?

One reason for more people suffering from OA - and hence the perceived need for orthopaedic surgery - is the rise in obesity. US orthopaedic surgeon Dr William M. Mihalko cites obesity as a strong risk factor for chronic pain. In his report, Obesity, Orthopaedics, and Outcomes, he and his colleagues found obese teenagers were more likely to report musculoskeletal pain compared to their friends who were a healthy weight. And, when orthopaedic operations become an option for obese patients, the surgical risks are higher and the problems aren’t necessarily solved.

What are the non-surgical options?

Since surgery can come with complications, both during and post-operatively, Dr Mayhew believes the focus should be on alternative treatment plans. “We should use physical therapy, weight loss, and injection-type therapies rather than orthopaedic surgery at times.” One example is with Achilles tendon ruptures. “The available evidence now is that non-surgical treatment is as good if not better than surgical treatment,” says Dr Mayhew. In their Model of Care report, Osteoarthritis (OA) Victoria says diagnosis of OA doesn’t require X-rays and other medical imaging, and that treatment plans should be holistic in approach.

As for reducing knee injuries, the researchers of the report in the Medical Journal of Australia believe there’s a need for a national ACL prevention program.

How to get a second opinion

Just as you may shop around for a new car or receive several quotes for renovating your kitchen you can apply the same principle to healthcare. A second or even third opinion on an existing medical condition can make a big difference to quality of life. “Going from a sore knee straight to an orthopaedic surgeon can often only lead to one option [surgery],” says Dr Mayhew. “A physical therapist or other specialist can help a patient explore non-surgical treatment options that may successfully resolve an issue without surgery, and the risks associated with that,” he adds.

This is at the heart of the Best Doctors service that offers eligible MLC Life Insurance customers access to a network of leading international experts. Almost one-third of musculoskeletal cases reviewed by Best Doctors resulted in suggested treatment change, proving the importance of other opinions.
One member who had been diagnosed with scoliosis was recommended spinal surgery however, following a second opinion from a Best Doctors leading orthopaedic surgeon, she was instead recommended pain relief medications and further testing as an alternative to surgery – of which she had undergone before to no benefit. “Getting the appropriate advice is paramount,” says Dr Mayhew. “An independent, non-biased opinion on appropriate management is very useful,” he adds.

A ripple effect of benefits

Reductions in orthopaedic surgery can have positive effects beyond patient health, including lessening the cost to the healthcare system and improving productivity in the workplace. OA Victoria calculates more than $200 million could be saved by 2030 and an annual reduction of $10 million in welfare payments to OA sufferers off work due to surgery and/or post-operative issues.

About Best Doctors

With an eligible policy from MLC Life Insurance, you and certain of your family members can access Best Doctors – a service which connects you with a network of more than 50,000 leading medical specialists from Australia and around the world for a second medical opinion when you need it most, helping to ensure you have the right diagnosis and treatment plan. Learn more about Best Doctors.


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The information provided is not intended to constitute financial, legal or medical advice, or to substitute for the need to consult with your advisers or treating practitioners. Before acting on any information in these pages, you should consider whether it is right for you and consult with your financial, legal and/or medical advisers.

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