Clinical improvement after certain surgical procedure is a fundamental aspect when evaluating success of a surgical treatment. The most important aspect is outlined in a question: “How would have this patient fared without the procedure?”. This is also major paradigm in the surgical and orthopaedic research. Our clinical experience is usually based on observations how patients got better after surgery but we rarely truly consider the aforementioned questions.
Pedersen et al. investigated how patients responded to arthroscopic partial meniscectomy. Based on findings in 614 patients they concluded:
At three months after meniscal surgery, approximately half of the patients perceived their symptoms to have improved to an important degree, 4 in every 10 patients perceived their symptoms were satisfactory, and 2 in every 10 patients perceived the treatment to have failed.
We also need to engage on the counterfactual thinking: how many patients would perceive their symptoms have improved after seeing an orthopaedic surgeon recommending physiotherapy and rehabilitation? Maybe 1 in 10? Or 3? Or even 6 out of 10 patients? This is something we need to ask ourselves more often in orthopaedics.