Knee Surgery Proves No Better Than Placebo
HOUSTON, Jul 10, 2002 (United Press International via COMTEX) -- For
individuals suffering from osteoarthritis in their knees, a common type of knee
surgery has been found to be no more beneficial than a placebo, a new study
revealed Wednesday.
Researchers at the Houston VA Medical Center and at Baylor College of
Medicine came to this surprising conclusion after comparing various knee
treatments to placebo surgery on 180 patients with knee pain.
The patients were randomly divided into three groups. One group underwent
debridement, in which the damaged or loose cartilage is the knee is surgically
removed by an arthroscope, a pencil-thin tube that allows doctors to see inside
the knee. The second group received arthoscopic lavage, which flushes out the
bad cartilage from the healthier tissue. A third group underwent a placebo
surgery. They were sedated by medication while surgeons simulated arthroscopic
surgery on their knees by making small incisions on the leg, but not removing
any tissue.
During a two-year follow-up, researchers found no differences among the three
groups. All patients reported improvement in their symptoms of pain and ability
to use their knees. Throughout the two years, patients were unaware whether they
had received the "real" or placebo surgery.
However, patients who received actual surgical treatments did not report less
pain or better functioning of their knees compared to the placebo group. In
fact, periodically during the follow-up, the placebo group reported a better
outcome compared to the patients who underwent debridement.
"I was initially very surprised," Dr. Bruce Moseley, an orthopedics
professor at Baylor who performed both the real and placebo surgeries in the
study, told United Press International. "I could not imagine anybody
suggesting that anything we do in surgery would be beneficial from a placebo
effect. I associate placebo effect with pills."
When asked why patients responded so strongly to the placebo surgery, Moseley
said they believed they had been helped by surgery, which seemed to make a
difference in their perception.
"In my simple surgeon's explanation of this, the magnitude of placebo
effect is directly proportional to the patient's perceived intervention,"
Moseley explained.
Arthroscopic surgery has been used to treat knee problems since the 1970s,
Moseley said, but when it came to treating osteoarthritis of the knee,
"there was a section of the orthopedic community that remained
skeptical."
Dr. Kevin Stone, an orthopedic surgeon at the Stone Clinic and founder and
director of the Stone Foundation for Sports Medicine and Arthritis Research in
San Francisco, said arthroscopic lavage combined with debridement still has a
lot to offer knee patients with osteoarthritis.
"I think there is a beneficial effect for surgery alone if it's done in
accomplished hands and with the right patient preparation, but without that in
place it can be more harm than good," Stone told UPI.
However, Stone said it is "absolutely" possible patients can
achieve a placebo effect from a fake surgery. "Because when patients get
prepared for surgery ... they feel invested both financially, emotionally and
physically in the outcome," which in the end, can help them feel better.
Osteoarthritis of the knee is common among athletes and sports enthusiasts,
but can also occur among sedentary people who have suffered strain to their
knees. The condition occurs when the cartilage and bone around the knee joint
become damaged from wear and tear.
The findings are published in the July 11 issue of The New England Journal of
Medicine.
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Last modified:
December 17, 2008
