The story feels like a conversation among a lot of very smart people explaining hip surgery in a very compelling way, so compelling that you might miss the lack of evidence for the new method being touted in this story.
The descriptions in this story are well crafted, and the attempt to bring in a variety of voices about hip replacement should be commended. Ultimately, though, we were left with a big question mark about why this method of surgery was being promoted at this time. A careful reader might note that the headline could be applied to nearly any new medical technique. “New method for hip replacement wins favor with some surgeons” could easily be “new method for tummy tucks wins favor with some surgeons” or “new method for prostate removal wins favor with some surgeons.” There always will be “some surgeons” who favor one technique over another. That doesn’t make the technique worth promoting for free in a prestigious newspaper.
Newer isn’t always better and minimally invasive isn’t always better, either. We would love to have seen some actual evidence to back up all the statements such as “less muscle damage and inflammation,” “easier time with physical therapy,” and the like. The story is framed as the cautious, risk-averse, lawsuit-faring old guard of surgeons cutting into patients unnecessarily while the smart, caring, vanguard of high tech surgeons are pioneering this new way. But where is the evidence?
Though this story argues among newer vs. more established techniques, it overlooks a major point. What many surgeons currently are doing is pretty good. Available devices and techniques in the hands of an experienced surgeon are associated with marked improvements in pain, function and quality of life. Though not as good as what we were born with, widely available hardware will remain functioning for at least 20 years. This is the biggest problem with the story as told. It misses the simple fact that newer techniques (or devices) have a steep hill to climb to show superiority. Rather the story implies that the short-term recovery using this new approach is better in terms of recovery for the patient. This should be easy to prove – so why haven’t those espousing it done a real evaluation? Second, it is critical that any new device or technique also stand the test of time. As we learned with tragic consequences with metal-on-metal hip devices that were similarly touted without evidence by its surgical proponents, only longer-term follow-up will show whether this anterior approach leads to the 20 year results seen with current devices and standard implantation techniques.
There is no mention of costs.
The story does not quantify the benefits of the anterior approach to hip replacement, and so we give it a failing grade here. But it should be noted that the story, unlike many in this vein, actually points to the lack of evidence that the approach is superior. The story says: “‘He says that while he’s heard about the benefits of the anterior approach, he’s ‘not aware of a randomized, controlled trial comparing the posterior and anterior approach that shows a definite superiority of one over the other.’ What’s key is that ‘surgeons need to do the approach they’re most comfortable with to get the best outcomes.’”
The clear implication in this story is that most doctors aren’t doing this technique because of convenience around retraining. It should have been pointed out that if there were stuies showing a clear benefit, providers would be morally pushed to make the effort and appropriately pushed by well-informed patients.
The only mention of harms in this story is by way of showing that the more “invasive” method of hip surgery is more damaging to muscle and tissue. Again, the story is framed as a risk-free operation that most surgeons are ignoring and an awful, damaging technique that leaves people teetering like Charlie Chaplin.
There are passing references to several studies in this piece but never an independent analysis of what the studies found or how they were conducted.
There is no disease mongering in this story.
The story quotes a wide variety of sources. We wish that more of the “old guard” were represented, but we give it a pass here.
The story does compare the two alternatives on several different fronts. But it always felt like an uneven playing field. The evidence wasn’t quantified. And so the story may oversimplify the debate between anterior and posterior approaches. Less invasive posterior techniques have been developed and are employed by many surgeons. It would have been helpful for the story to have surgeons comment on the relative benefits perceived between the anterior approach and less invasive posterior techniques. It may not be just an anterior vs. posterior issue.
The story spends a lot of time discussing why this technique is still only practiced by a minority of physicians, but it is clear that it is a widely available option.
The relative novelty of the anterior approach to hip replacement surgery is clear in the story. In other words, not all that new anymore.
The story does not rely on a press release.