| Summary: | Performed more than 600,000 times annually in the USA alone, total knee arthroplasty is the one of the
most common and costly elective operations in theworld. A primary total knee arthroplasty is generally an
elective procedure, for which total index hospitalization costs are estimated around $30,000 USD. Roughly
four in five patients declare they are satisfied postoperatively, justifying the procedure’s frequency and
high costs. It is sobering to realize, however, that the evidence base in favor of this procedure remains
circumstantial.We as a profession lack randomized trials showing a subjective improvement over placebo
intervention. We argue for the necessity of sham-controlled surgical trials in this setting and provide a
surgical atlas showing how a sham operation may be performed.
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