Sham knee surgery just as good as the real thing

In an interesting research project published in the July 11, 2002 issue of the New England Journal of Medicine (NEJM) comes a study of the effectiveness of knee surgery on the elderly. What may be most interesting about this study is that some patients in the study got “sham surgery” instead of the real thing. Presently, the popular knee surgery is performed on about 300,000 mostly elderly patients per year.  Arthroscopic knee surgery for osteoarthritis costs roughly $5,000, per operation or a total of $1.5 billion a year in the United States.

The NEJM study states that many patients report symptomatic relief after undergoing arthroscopy of the knee for osteoarthritis.  However, researchers are not sure why patients report such relief.  To investigate this researchers and surgeons at the Houston VA Medical Center divided 180 potential knee surgery patients into three groups. One group got arthroscopic débridement, one group received arthroscopic lavage, while the third group got placebo surgery.  Patients in the placebo group received skin incisions and underwent a simulated procedure without actual insertion of the arthroscope. The patients in the study did not know which group they were being divided into and therefore did not know if they were receiving the real or fake surgery.

All the patients who participated in the study were evaluated for two years after the procedure. During this time these patients still did not know which group they were in or if they received the sham surgery. The results showed that during the two year follow up, all three groups said they had slightly less pain and better knee movement. However, the sham-surgery group often reported the best results. Researchers attribute this to the well-known “placebo effect,” in which patients feel better simply because they believe they have been treated.

These findings could prompt insurance companies to refuse to pay for the procedure. In the Associated Press story on this study  Dr. William W. Tipton Jr., executive vice president of the American Academy of Orthopedic Surgeons, suggested that other researchers should conduct a similiar study and duplicate the results before doctors, patients and insurance companies react.  But he did confirm that the study confirms some doctors’ growing suspicions about these procedures.

Dr. Todd P. Stitik, associate professor of rehabilitation at University of Medicine and Dentistry of New Jersey in Newark, said patients he has sent for arthroscopic surgery were not helped much.  “I don’t think this is now necessarily a reasonable option,” he said.


Dr. Darryl Roundy

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