Keyhole surgery no more effective than placebo

According to a study report published this week in the BMJ, keyhole surgeries are no more effective than placebo surgery for patients with shoulder pain.

In a press release, the University of Helsinki said the study titled Finnish Shoulder Impingement Arthroscopy Controlled Trial (FIMPACT) compared surgical treatment of shoulder impingement syndrome to placebo surgery.

Two years after the trial the study participants, both those in the group who underwent keyhole surgery and the ones in the placebo group, had equally little shoulder pain and were equally satisfied with the overall situation of their shoulder.

“These results show that this type of surgery is not an effective form of treatment for this most common shoulder complaint. With results as crystal clear as this, we expect that this will lead to major changes in contemporary treatment practices,” said the study’s principal investigators Chief Surgeon Mika Paavola and Professor Teppo Järvinen from the Helsinki University Hospital.

Shoulder problems are very common and place a significant burden on the healthcare system. The most common diagnosis for shoulder pain that requires treatment is shoulder impingement, and the most common surgical treatment is decompression through keyhole surgery, i.e., arthroscopy.

“With nearly 21,000 decompression surgeries done in UK every year, and ten times that many in the United States, the impact of this study is huge,” explained Adjunct Professor Simo Taimela, research director at the Finnish Centre for Evidence-Based Orthopedics (FICEBO) at the University of Helsinki.

This research confirms previous randomised studies showing that keyhole decompression surgery of the shoulder does not alleviate the symptoms of patients any better than physiotherapy. Paradoxically, however, the number of decompression surgeries has increased significantly, even though solid proof of the impact of the surgery on the symptoms has been lacking.

The FIMPACT study involved 189 patients suffering from persistent shoulder pain for at least three months despite receiving conservative treatment, physiotherapy and steroid injections. Patients were randomised to receive one of three different treatment options — subacromial decompression surgery, placebo surgery (diagnostic arthroscopy, which involved arthroscopic examination of the shoulder joint but no therapeutic procedures) or supervised exercise therapy. No one involved in the study, including the patients, the persons involved in their care after surgery, and the researchers who analysed the results, knew which patient was in the decompression or placebo group.