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What happens when surgery is tested against a fake procedure?

3 hours ago
3 min read

If you've had surgery or you're on a waiting list, this isn't about second-guessing that decision. It's about making sure everyone knows all their options.



What the research found


This meta-analysis pooled 23 trials (2,412 people) comparing procedures such as surgery and injections with a sham (placebo) version for musculoskeletal conditions, which affect muscles, bones, joints, tendons and ligaments. In 18 of the 23 trials (78%), the real procedure did no better than the sham, and in some the placebo group did better.


For example, vertebroplasty (cement injected into a fractured vertebra) and shoulder decompression surgery showed no extra benefit, and radiofrequency and disc procedures for back pain showed no consistent benefit.


Confidence in the evidence ranged from moderate to very low, and this doesn't mean these procedures are never useful for anyone. The review also only included certain conditions and procedures, so it can't tell us about every surgery.



Our take


Being in the business of conservative care (non-surgical options like exercise-based rehab), of course we enjoy seeing studies like this, so there's a little confirmation bias here. Still, it's an important reminder to think carefully before deciding on surgery, which can come with significant risks and costs.


It's still common for people to end up seeing a surgeon before they've had a chance to try conservative care. Some surgeons, including our local orthopaedic surgeons, will recommend conservative treatment first anyway, which shows how much this approach is about working together. And surgery is still a great option for some problems: total hip replacement for severe hip osteoarthritis, for example, has strong evidence behind it.



What this means for you


For most non-urgent muscle and joint problems, it's worth giving well-guided conservative care a proper go first, and talking through all the options with your GP or surgeon before deciding.



Want to go further? A surgeon worth listening to


In a world overloaded with myths and misinformation, here are some resources we've really enjoyed and believe are accurate and trustworthy. They're created by Dr Howard Luks, an orthopaedic surgeon in the US.


What we love is the honesty. You'd naturally expect a surgeon to be pro-surgery, but the opposite is true! In his podcast and Substack posts, he shares the research around surgery (which is often surprising), and how lifestyle factors are often a better option for managing and preventing conditions that affect joints, bones, tendons, ligaments and muscles.


He also shares his own experience and very practical advice for staying active in midlife and beyond, so it's a great fit if you're in your 40s, 50s or older and want to keep moving well.






References


Dutra, M. N. P., Canez, M. S., Pereira, B. R., Dias, J. B., Luza, L. P., & de Araujo, F. X. (2026). Invasive procedures for most musculoskeletal conditions are not better than placebo: A systematic review with meta-analysis. Musculoskeletal Care, 24(3), e70244. https://doi.org/10.1002/msc.70244







Written by


Samuel Bulten

Exercise Physiologist | Masters in Medicine (Pain Management)

Director, Adapt Movement


Disclaimer


This information is for educational purposes only and is not a substitute for personal medical advice. These blogs are written by Sam Bulten and represent his opinions and insights and are based on his experience and interpretation of the research. As Sam is a human, these opinions and insights are not absolute truths.



 
 
 

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