This is a well-reported news story about hip replacements that squeak. The story covers all the basics—including the availability, costs, novelty, harms, and benefits of the implants. It provides a reasonable description of the evidence and treatment options, and is loaded with sources and case studies. If there is a problem with the story, it is the suggestion that squeaking is unique to implants made from ceramic. While the Times story cites a study showing “no squeaks occurred among … patients who received hips made of metal and plastic,” some researchers say metal and plastic hips emit noise as well.
The article states that the costs are “generally … close to $45,000.”
The news story notes in a sentence that hip replacement has a success rate of more than 90%, and defines “success” as “relatively pain-free mobility.” The article also clearly states why this new device was developed — to provide longer lifetime use prior to device failure. It quantifies this benefit vaguely, saying the device is "much more durable" and lasts "much longer."
The news story focuses on one main harm—squeaking in hip implants made of ceramic—and provides estimates of its prevalence. A spokesperson for the hip maker points out that hip replacement has other potential risks as well, including infection, dislocation, and leg-length discrepancy.
The news story makes it fairly clear that the research it is citing is from cohort studies.
The first mention of the prevalence of squeaking in ceramic hip implants appears to cite the highest known estimate—7% of ceramic implants in one study of 143 patients. Only later do readers discover that other studies suggest the prevalence of the problem may be much smaller, from 3% (in a study of 1500 people) to less than 1%. This is not disease mongering, but it could cause some people to fear ceramic hip implants more than may be justified. In addition, the Times article says no squeaking occurred in patients with metal and plastic implants. But a recent 2007 review in the Journal of Bone & Joint Surgery (JBJS) reported that squeaking in similar implants made out of metal and plastic occurred in 4% of patients. (JBJS 2007;89:1874-85) If the JBJS review is accurate, the news story would be misleading. Unfortunately, the JBJS failed to support its own contention with a complete reference.
The story cites 4 patients, 4 surgeons, a spokesperson for implant maker Stryker, and a lawyer representing aggrieved patients. All in all, they provide a balance of viewpoints. The story mentions a conflict of interest for one surgeon. It appears that 2 of the patients are clients of the lawyer.
The story points out that the alternatives to a ceramic total hip replacement include hip replacements with implants made from metal and plastic. It doesn’t mention whether there are nonsurgical alternatives to hip replacement, but this is beyond the scope of the story.
The story does not explicitly state that ceramic hip replacements are approved by the FDA, but with “tens of thousands” implanted, it’s clear that surgeons’ adoption of the devices is widespread. The FDA’s warning to implant maker Stryker about squeaking suggests the devices may not be perfect, but are approved.
The story notes that Stryker introduced ceramic hip implants into the U.S. in 2003.
The story cites several sources and does not appear to rely solely or largely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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