Authors: Khalaf A. Alnowaishiri , Ahmed Saeed M. Alqahtani , Bader Sulaiman Althunayyan , Ghaida M. Alanbari , Hasan Ali AlGharib , Mohammed H. Hwaifr , Naif M. Alqahtani , Turki F. Alrashidi , Ismail H. Almogbil

Abstract

Background: To assess whether sham procedures offer comparable outcomes in pain relief, function, quality of life, and adverse events.

Methods: The literature search was conducted across the PubMed, Scopus, and Cochrane Library databases (2014-2024). Eligible studies included randomized controlled trials and observational studies comparing sham and actual orthopedic surgeries. Data was extracted and pooled using Review Manager 5.1.4, with standardized mean difference (SMD) as the effect size metric. A random-effects model accounted for heterogeneity. Risk of bias was assessed using the Cochrane tool.

Results: Seven studies were included. The meta-analysis showed a statistically significant difference favoring real surgery for pain outcomes (SMD = -0.73; 95% CI: -1.23 to -0.22; p = 0.005), with high heterogeneity (I² = 89%). Functional outcomes (185 participants across 3 studies) showed no significant difference (SMD = -0.07; 95% CI: -1.04 to 0.89; p = 0.88; I² = 90%). For quality of life (342 participants across 5 studies), the difference was also non-significant (SMD = -0.09; 95% CI: -0.47 to 0.30; p = 0.66; I² = 77%). Adverse events (298 participants, 3 studies) showed a trend toward increased events in the surgery group (SMD = 3.66; 95% CI: -0.38 to 7.69; p = 0.08; I² = 99%).

Conclusion: Sham surgeries produced outcomes similar to real procedures in function, quality of life, and adverse events. However, real surgery provided greater pain relief. These findings suggest that while placebo effects play a role in patient improvement, some orthopedic surgeries still offer meaningful benefits, especially for pain.

Keywords: Orthopedic procedures, pain management, placebos, treatment outcome, quality of life.