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.
The story cites a cost of ~$40,000 exclusive of hospital costs, and says this is roughly the same as traditional total joint replacement.
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.)
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”).
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.
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).
Hip and knee osteoarthritis afflict millions of Americans, and this story fairly represents their predicament.
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.
The article compares the new surgical techniques to traditional total joint replacement, and explains why it may be better or worse than longstanding approaches.
The story says nearly half of all total joint surgeries are now being done with so-called “minimally invasive” approaches.
The article explains that minimally invasive hip replacements are relatively new and were “pioneered in the early part of this century.”
There is no obvious use of text from the press release.