News in brief: Little evidence to support most orthopaedic surgeries; Mandatory vaccination needed for all hospital staff; PRP treatment no benefit for patients with Achilles tendinopathy;

Missing: evidence of efficacy for most elective orthopaedic surgeries

Most of the most commonly-performed elective orthopaedic surgeries for musculoskeletal conditions have little strong, high-quality evidence supporting their use over non-operative alternatives, according to a new review.

Although randomised controlled trials have shown carpal tunnel decompression and total knee replacement’s superiority over non-operative care, those for arthroscopic anterior cruciate ligament reconstruction, partial knee meniscectomy, rotator cuff repair, subacromial decompression and lumbar spine decompression or fusion have not.

No randomised controlled trials have compared total hip replacement or knee meniscal repair’s efficacy with non-operative care, University of Bristol’s Professor of Orthopaedic Surgery, Ashley Blom and his team reported in BMJ.

“Despite the lack of strong evidence, some of these procedures are still recommended by national guidelines in certain situations,” the authors said.

When selecting treatments, clinicians should “apprise themselves of the evidence, make decisions based on the highest quality trials available, and, in the absence of these, base their judgment on observational evidence, acknowledging that this may be imperfect,” they said.

Mandatory vaccination needed for all hospital staff

The Morrison government is being urged to make vaccinations compulsory for all hospital staff across Australia and have a roll out plan to provide vaccine every hospital worker.

The peak body representing Catholic not-for-profit hospitals, Catholic Health Australia (CHA), says the Federal government already has a mandatory vaccination scheme for aged care and should put in place a similar scheme for all hospital staff across Australia, public and private.

CHA says its hospitals are already redeploying unvaccinated staff to clinical areas where there is a lower risk of contact with COVID patients and vaccinating staff as and when Commonwealth supplies become available.

“Every year health care staff are required to get vaccinated against the flu and yet there’s no such directive for COVID,” said CHA’s Health Policy Director James Kemp.

National Cabinet should bring in a uniform rule for mandatory COVID vaccination for hospital staff – regardless of whether they work in ED, ICU or any other clinical or support position, he added.

“The high transmissibility of the Delta variant of COVID is putting workers and the people they care for at greater risk as well as putting extra strain on staff,” he said

Mr Kemp said: “Every worker should have a date in their diary to get vaccinated. Every dose that comes into the country should have a hospital worker’s name next to it.”

PRP treatment no benefit for patients with Achilles tendinopathy

Patients with Achilles tendinopathy receive no benefit from being treated with platelet rich plasma (PRP) injection, a randomised trial finds.

Published in JAMA and funded by Versus Arthritis, the trial concludes that PRP treatment, often used for orthopaedic issues and by professional sports people, should no longer be used to treat the condition.

The trial involved 240 patients with Achilles tendinopathy who were randomised to receive PRP treatment or sham. At three and six months there was no difference between the groups in pain, function and activity as measured by the Victorian Institute of Sport Assessment – Achilles score (VISA-A).

Lead author of the study Professor Rebecca Kearney of Warwick Clinical Trials Unit at the University of Warwick said: “The recommendation from this trial is that PRP should not be used to treat Achilles tendinopathy. It’s not effective, it costs money and we found some evidence that it can cause harm in the short term. There’s no evidence to continue using it for Achilles tendinopathy.

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