Common shoulder surgery does not offer benefit to the patient
Keywords:The Finnish FIMPACT trial (Finnish Subacromial Impingement Arthroscopy Controlled Trial) has in a follow-up of ten years shown that surgery does not offer any benefit compared to other forms of treatment. According to studies, decompression surgery (arthroscopic subacromial decompression, ASD), which has long been used in the treatment of shoulder pain, does not reduce the pain or improve functional capacity or the quality of life when compared to placebo surgery or intensified physiotherapy.
Associate Professor, Specialist in Orthopedics and Traumatology Mika Paavola.
Subacromial pain has traditionally been considered to be caused by tightness of the space underneath the acromion. Over the decades, the decompression surgery developed on the basis of this theory became one of the most common orthopedic procedures. Although research evidence has repeatedly questioned the effectiveness of the surgery, it continues to be offered to patients with prolonged pain.
Arthroscopic subacromial decompression does not bring benefits
In the trial, 189 patients were randomized into three groups: decompression surgery, placebo surgery and intensified physiotherapy. In the 10-year follow-up, the results remained the same as at two and five years from surgery: all groups recovered equally well, but the decompression did not bring any additional benefit.
“FIMPACT is the only trial in the world, in which the long-term effects of arthroscopic acromial decompression have been assessed in a placebo-surgery setup. The results are clear and this widely used procedure is not an effective form of treatment.” says Associate Professor Mika Paavola, Specialist in Orthopedics and Traumatology.
According to the study, almost all patients recovered, but recovery occurred regardless of whether the form of treatment was decompression surgery, a placebo procedure or physiotherapy.
Impact on treatment practices and costs
“There has been a dramatic drop in the number of ASDs in Finland: in the peak year 2012, about 7,600 procedures were performed and in 2023, only fewer than 600. This has saved up to more than EUR 250 million and, above all, reduced unnecessary surgeries and sick leaves. The estimate of cost savings is based on the calculation method used in international research,” says Specialist in Orthopedics and Traumatology Kari Kanto, MD, from the FICEBO research group of the University of Helsinki.
Link to research article: Arthroscopic subacromial decompression for subacromial pain syndrome | The BMJ