title: Sham Surgery in Orthopedics: A Systematic Review of the Literature.
abstract: To evaluate the evidence for the effectiveness of sham surgery in orthopedics by conducting a systematic review of literature.
  
  
  
  Systematic searches were conducted on Biomed Central, BMJ.com, CINAHL, the Cochrane Library, NLM Central Gateway, OVID, ProQuest (Digital Dissertations), PsycInfo, PubMed/Medline, ScienceDirect and Web of Science. Secondary searching (PEARLing) was undertaken, whereby reference lists of the selected articles were reviewed for additional references not identified in the primary search. All randomized controlled trials comparing surgery versus sham surgery in orthopedics were included. Data were extracted and methodological quality was assessed by two reviewers using the Critical Review Form-Quantitative Studies. Levels of scientific evidence, based on the direction of outcomes of the trials, were established following the Australian National Health and Medical Research Council (NHMRC) Hierarchy of Evidence (Australian National Health and Medical Research Council, 1999).
  
  
  
  This review includes six randomized controlled trials (RCTs) involving 277 subjects. All six studies were rated as very good on methodological quality. Heterogeneity across the studies, with respect to participants, interventions evaluated, and outcome measures used, prevented meta-analyses. Narrative synthesis of results, based on effect size, demonstrated that sham surgery in orthopedics was as effective as actual surgery in reducing pain and improving disability.
  
  
  
  This review suggests that sham surgery has shown to be just as effective as actual surgery in reducing pain and disability; however, care should be taken to generalize findings because of the limited number of studies.
authors.affiliation: International Spine Pain Institute, Story City, Iowa, USA.|Department of Physiotherapy, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Adriaan
authors.initials: A
authors.lastname: Louw
authors.affiliation: Department of Physiotherapy, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Ina
authors.initials: I
authors.lastname: Diener
authors.affiliation: International Spine Pain Institute, Story City, Iowa, USA.|Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
authors.forename: César
authors.initials: C
authors.lastname: Fernández-de-Las-Peñas
authors.affiliation: International Spine Pain Institute, Story City, Iowa, USA.|Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA.
authors.forename: Emilio J
authors.initials: EJ
authors.lastname: Puentedura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D009985:Orthopedics / Q000706:statistics & numerical data*; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D015990:Placebo Effect; D010919:Placebos; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010919:Placebos
keywords: Neuroscience; Orthopedics; Pain; Sham; Surgery