To cut or not to cut…. that is the question?

by Physio Thomas

So, you have been told by your doctor that your knees are “bone-on-bone,” or your back pain just isn’t getting better. Or you know someone who has had a hip replacement, and feels great, but someone else who hasn’t recovered so well. Should you get that surgery – that fusion, arthroscopy, or replacement – or should you try a more conservative route?

There is often ambivalence when choosing between surgical or non-surgical treatments, and it is important to weigh up your options. This article will go through some surgeries you may have heard of, and how physiotherapy can help you before, after, or even instead!

Current Evidence for some common Orthopaedic Surgeries

Orthopaedic surgeries refer to surgeries for problems related to bones, joints and ligaments, and are typically performed to reduce pain or improve function. Some common ones include fusions (joining two bones together), arthroscopies (removing damaged pieces of bone or cartilage other tissue) and joint replacements.

Orthopaedic surgeries are the third most common reason to go under the knife, and, unfortunately, their popularity stems from decades-old evidence and the allure of a relatively quick-fix.


However, recent evidence from Ferreira et al. (2022) states that:

  • Many common orthopaedic surgeries are not better for reducing pain than non-surgical alternatives.
  • 1 in six patients undergoing a spinal fusion experience serious complications, including infection, blood clots, nerve injuries and heart failure.
  • Arthroscopies to treat osteoarthritis, knee wear-and-tear, and to remove inflamed and thickened tissues in the shoulder,have similar results to placebo surgery – that is, where they just pretend to do the surgery.
  • In regards to quick-fixes, only one in five workers with spinal fusions returned to work after two years, and shoulder arthroscopies have a recovery period of up to six weeks to even lift the shoulder above the head.

It is important to note, though, that some orthopaedic surgeries are a necessity and best option, especially in the case of severe trauma or deformity, like a fracture. However, it’s when they’re prescribed to treat general wear-and-tear or apparent weakness one needs to sit and strongly consider whether the risks (and there are plenty)do not outweigh the expected benefits.

Conservative therapy approaches

So, what do you do? If these orthopaedic surgeries don’t work (or don’t work as well as you had expected), how will you get better?

Shockingly, we at Vital Core Physiotherapy suggest physiotherapy.

Now, you may be thinking, oh, of course, the physiotherapist is going to suggest physiotherapy. But, hear me out:

  1. There is strong evidence to support conservative interventions (specific, individualised and progressive exercise programs) for shoulder and back pain.
  2. Non-surgical alternatives, such as exercise, are safer – surgeries, by definition, are traumatic, and secondary complications can occur, such as hospital-acquired pneumonia or issues with anaesthetics.
  3. Non-surgical approaches are cheaper.
  4. These surgeries may not solve the root of the problem, such as impaired movement patterns or loading which leads to ongoing or other problems.
  5. Also, guess what orthopaedic surgeons prescribe after your surgery? Physiotherapy. You will be prescribed exercises to ensure an adequate recovery, and doing them are pivotal to regaining function and strength.
  6. If after completing prescribed physiotherapy, if you still really want surgery it is always still an option. However if you perform surgery and remove or alter the body, there is no going back if you are not happy with the results!

So, conservative approaches are proven to be effective for pain management and function, cost less, and are safer. But, what’s best about physiotherapy management is that there is no harm even if it doesn’t work as well as you want. Research shows that doing physiotherapy exercises before surgery (called pre-habilitation) reduces chances of complications after the surgery, and increase your chances of returning to function and sport – so it’s a win-win!


Nobody wants to be in pain or have impaired function, and it is a tough decision whether to have surgery. We, at Vital Core Physiotherapy, will support your choices, and create a plan that suits you, your goal, and whatever your outcome may be. However, it’s important to consider the evidence, and the risks versus rewards – there are benefits to beginning with a physiotherapy plan, and if it works well, you may not even need that surgery after all.

(Full article here)