Which Surgeries Are No Better Than A Sham?

Orthopaedic surgery involves care of the musculoskeletal system and includes a variety of surgeries including joint replacements and arthroscopies. A recent review of 53 trials assessing surgical outcomes found that about half of placebo surgeries worked just as well as the actual surgeries. 1

So which surgical procedures should we think twice about?

Arthroscopies

A knee arthroscopy (eg. partial meniscectomy, debridement), commonly called a ‘clean-out’ is an excellent example of sham surgery. A 2017 study found no difference at a 2 year follow up between  arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear.2 Several additional studies have supported these findings and concluded that “surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.”3,4

Spinal surgery

A trial assessing vertebroplasty (used to treat spinal fractures) at 1 month post surgery found that clinical improvement in patients with fractures was similar among both those treated with vertebroplasty and those treated with placebo surgery.5

Spinal fusion may also not be successful long term – one in five patients requires reoperation within 4 years after surgery.6 Another paper concluded that there is “strong evidence that lumbar fusion is not more effective than conservative treatment in … chronic low back pain among patients with degenerative spinal diseases.”7

 

Other suggested sham surgeries include shoulder rotator cuff repair and tennis elbow debridement.

 

What does all this mean?

As health practitioners, our goal is to provide evidence based management to our patients. We aim to educate our community about which situations surgery can be an effective solution for. Whilst there is certainly a place for surgical intervention in the management of some conditions, studies are suggesting that several commonly performed orthopaedic surgeries are merely a placebo.

 

References:

 

  1. https://www.bmj.com/content/348/bmj.g3253
  2. https://www.nejm.org/doi/full/10.1056/NEJMoa1301408#t=article
  3. https://www.nejm.org/doi/full/10.1056/nejmoa1305189
  4. https://www.nejm.org/doi/full/10.1056/NEJMoa013259
  5. https://www.nejm.org/doi/full/10.1056/NEJMoa0900563
  6. https://journals.lww.com/spinejournal/Abstract/2018/02150/Reoperation_Rates_Following_Instrumented_Lumbar.20.aspx
  1. https://www.ncbi.nlm.nih.gov/pubmed/23820296
  2. https://www.ncbi.nlm.nih.gov/pubmed/24753240
  3. https://www.physio-network.com/many-orthopedic-surgeries-dont-work/





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Our Southbank Chiropractic clinic is located at Level 2, Suite 14, 51-55 City Road, Southbank