When we stop “treating” degeneration?

This is a second post about an excellent Invited Paper in the International Orthopaedics. Authors begin their paper as follows:

The specialism of orthopaedic surgery covers many subdisciplines. Most of these deal with degenerative changes occurring as a result of the normal aging process. Some will follow trauma or are as a result of congenital malformations. Patients, however, are pre-conditioned to look for a ‘cure’ and are not that happy to learn if one is not available. It is more likely that the aging or degenerative process will be ‘managed’ throughout the patient’s life time. […] These patients need careful handling as they need to understand that the aging process cannot be cured and resultant symptoms can only be managed. There are many both operative and conservative options, but the aim is to control the symptoms they experience to allow a return to function as close to normal as possible. 

Emphasis added

This is certainly a nice recap of the orthopaedic practice. Lots of surgeries have been done to “treat degeneration”. These include arthroscopic partial meniscectomy and subacromial decompression to name a few. Recent evidence shows that these surgeries have very little if any clinical benefit for our patients. This is also a very plausible finding: both surgeries are used to treat a conditions which are part of normal ageing and degenerative processes. Those cannot be healed. And this very same applies to variety of other orthopaedic surgeries and conditions.

As I and my colleague Teemu Karjalainen wrote recently, there is a clear need for a paradigm shift in our field:

It may be time for a paradigm shift: Embrace the natural course and accept degeneration until effective treatments arise.

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