Friday, January 3, 2014

Sham Surgery for Knee Pain


A fake surgical procedure is just as good as real surgery at reducing pain and other symptoms in some patients suffering from torn knee cartilage, according to a new study that is likely to fuel debate over one of the most common orthopedic operations.
[R]esearchers in Finland who studied two sets of patients—one that received the surgery, and another that was led to believe that it had—observed no significant differences in improvement between the groups after one year.
"The implications are fairly profound," said Jeffrey Katz, a professor of medicine at Brigham and Women's Hospital in Boston who wasn't involved in the Finnish study. "There may be some relatively small advantages to meniscal surgery, but they're short-lived."
The study is likely to stir controversy over the minimally invasive procedure, known as partial meniscectomy, which can cost between $3,000 and $6,000. The study's authors estimated that it accounts for $4 billion in annual medical costs in the U.S.
Teppo L.N. Järvinen, one of the study's authors, said he was uncertain whether the research paper would change clinical practice. A previous study showed that physical therapy was just as effective as surgery for patients with both a meniscal tear and osteoarthritis, but many physicians have continued to recommend the procedures anyway, he said. "Doctors have a bad tendency to confuse what they believe with what they know," said Dr. Järvinen, an orthopedic resident and adjunct professor at Helsinki University Central Hospital.

Here's the abstract of the NEJM article. Of course, they should have had a third group of controls -- candidates for knee surgery who were put on a wait-list and their pain and functioning measured after one-year. If there was no difference between the wait-list controls and the surgery patients, then you would have a compelling case that the surgery is worthless. With the present study, all you have is yet another demonstration of the power of the placebo effect (i.e., people who think that they had an effective surgery do as well as people who had the actual surgery).

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