A review by Blom et al. (2021), aiming to examine the clinical effectiveness of common elective orthopedic surgical procedures compared with no treatment, placebo/sham, or non-operative care, was published in The BMJ in July. The review authors made an astonishing conclusion: The effectiveness of many commonly performed elective orthopedic operations over non-surgical comparisons were not backed by “readily available high quality evidence, mostly owing to a lack of definitive randomised controlled trials” (Blom et al., 2021). This study has sparked heated debates and discussions among clinicians and researchers in the field of orthopedics. Here in this OE Original, we examine the evidence presented by The BMJ review in-depth. Moreover, we argue in this OE Original that the issue of “lacking-sham-controlled-surgical-trials” reflects the methodological and practical challenges faced in the design and conduct of surgical randomized controlled trials (RCTs) using sham control. This problem is not ....