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New Doubts About Popular Joint Surgery


4 Star

New Doubts About Popular Joint Surgery

Our Review Summary

This story takes a skeptical look at the heavily marketed procedures known as minimally invasive total joint replacements. It does a nice job of pointing out the problems patients are experiencing, the surgeons’ relatively steep learning curve with the new techniques and tools, and the absence of long-term data comparing the new technique to traditional total joint replacement. It draws on a deep bench of sources representing a variety of viewpoints– three patients, three orthopaedic surgeons, and one industry spokesperson.

However, the story fails to describe the quality of evidence showing that the new techniques may cause more problems than the traditional approaches, and it omits mention of high-quality published studies that support this point. It also fails to quantify the purported benefits of the new techniques, though several studies have looked at them. What are readers to make of the suggestion that “proponents” say the new approach shortens recovery times or reduces postoperative pain? What do the data say? Do the purported benefits last beyond the first few weeks or months? The story does not mention published randomized controlled trials showing that there is no clinically important difference in outcomes beyond the immediate postoperative period in hips or beyond 9 months in knees.

By focusing on personal stories about complications, the story doesn’t deliver hard data about benefits. A more complete accounting of the evidence would help readers decide whether there are any extra benefits from the new approach that make added complications worthwhile.


Does the story adequately discuss the costs of the intervention?


The story cites a cost of ~$40,000 exclusive of hospital costs, and says this is roughly the same as traditional total joint replacement.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story’s focus is on harms of treatment, but readers are left wondering about its purported benefits. (e.g. cutting less tissue and muscle, shorter scar, quicker recovery, less postoperative pain). The story provides no quantitative estimate of these (or other) potential benefits, though several studies have looked at them. This is a major limitation of the news story. By focusing on personal stories about complications, the story doesn’t give readers the hard data about benefits they need to make a well-informed medical decision. (See evidence above.)

Does the story adequately explain/quantify the harms of the intervention?


The article provides ample reporting on the potential harms of minimally invasive surgery (e.g., “uneven leg lengths, broken hip bones, slightly off-kilter knee joints and pain in the knee because of hardened cement left in the wound”).

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story cites three studies to support its argument that minimally invasive surgery may not be as great as many people think. But the quality of the studies is unclear. And it’s puzzling why these particular studies are cited when better ones exist that would help support the same points.

  1. One published study analyzed 80 knee operations, some of them done the traditional way and some with minimally invasive techniques, but the story provides no clue about the quality of the study—it could be a fine randomized trial or a very weak retrospective case review.
  2. An unpublished study reporting a high rate of complications (9%) after 247 minimally invasive hip surgeries performed at community hospitals, but there was apparently no comparison group.
  3. And an apparently uncontrolled study from Taiwan (publication status unreported) showing that surgeons committed significantly more than the usual number of mistakes during 32 minimally invasive joint replacements.

The story does not provide any evidence to help readers judge whether the purported short-term advantages of minimally invasive procedures (promised “shorter recuperation times” and less postoperative pain) have proven true in carefully monitored studies. Yet published randomized controlled trials have shown that there is no clinically important difference in outcomes beyond the immediate postoperative period in hips (Dorr, J Bone Joint Surg Am. 2007;89(6):1153-60. Chimento, J Arthroplasty. 2005;20(2):139-44. Ogonda, J Bone Joint Surg Am. 2005;87(4):701-10) or beyond 9 months in knees (Karachalios, J Bone Joint Surg Br. 2008;90(5):584-91).

Does the story commit disease-mongering?


Hip and knee osteoarthritis afflict millions of Americans, and this story fairly represents their predicament.

Does the story use independent sources and identify conflicts of interest?


The story cites three patients, three orthopaedic surgeons, and one spokesperson for a company that manufactures the implants and tools used in the new procedure. 

Does the story compare the new approach with existing alternatives?


The article compares the new surgical techniques to traditional total joint replacement, and explains why it may be better or worse than longstanding approaches.

Does the story establish the availability of the treatment/test/product/procedure?


The story says nearly half of all total joint surgeries are now being done with so-called “minimally invasive” approaches.

Does the story establish the true novelty of the approach?


The article explains that minimally invasive hip replacements are relatively new and were “pioneered in the early part of this century.”

Does the story appear to rely solely or largely on a news release?


There is no obvious use of text from the press release.

Total Score: 8 of 10 Satisfactory


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