Orthobullets is an excellent educational platform. However, their case examples consistently seem to favor surgical treatment. This may, of course, stem from the generally surgery-oriented culture in the US. When compensation is tied to the number of operations performed, treatment preferences naturally reflect this.
A recent Orthobullets case in X featured a 78-year-old female patient with a limp and a gluteal tendon tear. Once again, the discussion centered around surgical treatment. I questioned the rationale for surgery in a patient nearing 80 years of age, given that tendons at this stage no longer possess regenerative properties.
Derek Moore asked “Do we need a RoHI index score for hip abductor tears?”
This highlights why orthopaedic science is amiss. Before we really need to study this, we need a solid answer to the following questions:
- What is the natural history of these tears?
- What is the prevalence of tears in asymptomatic and symptomatic patients?
- What is the benefit of surgery compared to a sham procedure?
Once we have thoroughly covered these, we can begin building a prognostic model or “index” study.