How do you decide when surgery is the best option, and who makes that call?

About half of orthopaedic surgical procedures have no scientific evidence from randomised trials proving they work better than non-operative treatment. Another 25% are no better than non-surgical alternatives. Yet many of these are still being performed on patients.

About 6000 people had ineffective treatments that cost up to $4400 in both public and private hospitals in 2010-11, according to a 2015 Grattan Institute report.

A keyhole surgery to treat a painful condition called shoulder impingement, where the tendons in the shoulder are trapped and compressed during movement.

A 2017 study from Oxford University found shoulder decompression surgery was no better at relieving pain than a placebo, and only slightly more effective than doing nothing at all.

Surgery to join two or more vertebrae together. The goal is to stop movement between the two bones and prevent nerve pain.

Randomised trials suggest spinal fusion has little advantage over a well-structured rehabilitation program or psychological interventions for back pain⁽⁴⁾.

Removal of a damaged hip joint, and the insertion of an artificial one.

The number of hip replacements done in Victoria increased 175% from 1994 to 2014⁽⁵⁾.

An arthroscopy can be used to diagnose and treat a range of conditions. A tiny camera is inserted through a small incision, allowing the surgeon to see the inside of the joint. Torn or damaged tissue such as cartilage can then be removed or washed out.

It’s the most common orthopaedic procedure, but several studies have challenged the effectiveness of arthroscopies for patients with osteoarthritis. An international panel of surgeons recently made a strong recommendation against arthroscopy for degenerative knee disease⁽³⁾.

A damaged knee joint is removed and replaced with an artificial one.

From 1994 to 2014, the number of knee replacements done in Victoria went up 285%⁽⁵⁾.