I believe one of the important research revelations of the early 21st century is that some but not all surgical procedures may not offer any benefit beyond placebo. With 2 new papers being released recently on surgery for meniscus tears and tennis elbow I wanted to document a few of the studies that have been done comparing a surgical procedure to a “sham surgery”.
In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM [Arthroscopic partial meniscectomy] were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who have failed initial conservative treatment are more likely to benefit from APM.
With the number of available participants, this study failed to show additional benefit of the surgical excision of the degenerative portion of the ECRB [extensor carpi radialis brevis, a muscle in the forearm that attaches to a ligament in the elbow] over placebo surgery for the management of chronic tennis elbow.
This study was part of a large double-blind sham surgery-controlled trial designed to determine the effectiveness of transplantation of human embryonic dopamine neurons into the brains of persons with advanced Parkinson’s disease. This portion of the study investigated the quality of life (QOL) of participants during the 1 year of double-blind follow-up…
The placebo effect was very strong in this study, demonstrating the value of placebo-controlled surgical trials.
In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure.
This study was often cited in relevant meta-analyses:
- Treatment of primary and secondary osteoarthritis of the knee.
- Arthroscopic debridement for knee osteoarthritis.
- Joint lavage for osteoarthritis of the knee.
- Three Treatments for Osteoarthritis of the Knee: Evidence Shows Lack of Benefit.
Not all surgeries are showing a lack of benefit. Here is a trial on laparoscopic excision of endometriosis that shows a benefit compared with placebo.
Laparoscopic excision of endometriosis is more effective than placebo at reducing pain and improving quality of life. Surgery is associated with a 30% placebo response rate that is not dependent on severity of disease. Approximately 20% of women do not report an improvement after surgery for endometriosis.
This difference highlights the importance of continuing to pursue research evaluating surgical procedures with placebo controls.