Most common surgery in the western world might be unnecessary

20 Jul 2018

Image: XiXinXing/Shutterstock

A new study claims patients undergoing one of the most common surgical procedures in the western world might be wasting their time.

A team of researchers from the University of Helsinki has spent the past two years comparing the results of patients living with shoulder impingement syndrome who underwent surgery with those who had placebo surgery where nothing took place.

Now, in the study published in The BMJ, the team claims that this surgery – one of the most common procedures in the western world – might not actually provide any real benefits compared with doing nothing.

The Finnish Shoulder Impingement Arthroscopy Controlled Trial involved 189 patients living with persistent shoulder pain for at least three months and who had been given a series of steroid injections, physiotherapy and conservative treatment.

The patients were then randomised to receive one of three treatment options: subacromial decompression surgery, placebo surgery in the form of diagnostic arthroscopy or simply supervised exercise therapy.

Once the therapies were administered, the patients checked in two years later and were asked about their satisfaction levels, with those in the subacromial decompression group asked who they thought had received a placebo procedure.

Avoiding useless surgeries

The results showed that, overall, shoulder pain was substantially improved in all three groups from the start of the trial, but decompression surgery appeared to show no more benefit than the placebo procedure.

The group that received exercise therapy also improved over time, to the point that patients who initially had decompression surgery were only slightly more improved than those who had physiotherapy only.

“Based on these results, we should question the current line of treatment according to which patients with shoulder pain attributed to shoulder impingement are treated with decompression surgery, as it seems clear that, instead of surgery, the treatment of such patients should hinge on non-operative means,” said Teppo Järvinen, one of the study’s principal investigators.

It is estimated that, in the UK alone, 21,000 decompression surgeries are undertaken each year, with nearly 10 times as many taking place in the US.

“By ceasing the procedures which have proven ineffective, we would avoid performing hundreds of thousands useless surgeries every year in the world,” Järvinen added.

Colm Gorey was a senior journalist with Silicon Republic