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Surgeons Move From Knees to Hips


2 Star

Surgeons Move From Knees to Hips

Our Review Summary

This news story introduces readers to arthroscopy as a treatment for hip pain. It explains what the procedure does and the theoretical basis for its potential benefit. But the story fails to mention costs or potential harms, and cites expert testimony in lieu of evidence.

In brief:

  • Costs and Harms: The story mentions neither. Although harms appear to be uncommon, readers should have some sense of their relative frequency and severity.
  • Evidence: the story says that hip arthroscopy can “fix” acetabular labral tears and femoroacetabular impingement. And yet it fails to describe the quality of the evidence to support this claim. There are virtually no high-quality clinical studies to support the treatment. The story also mentions that diagnostic imaging can be unreliable, and suggests that some doctors can pinpoint the diagnosis better than others. But recent literature reviews show that standard diagnostic techniques in use today (imaging and clinical examination) can not accurately or consistently identify the source of pain in people with hip complaints. Readers should understand that when diagnostic techniques are imprecise, people may receive treatments they don’t need or not receive treatments they do.
  • Quantification of Benefits: The story provides no quantitative estimate of benefit in the short or mid term. A surgeon contends that in the long term, “hip arthroscopy may be a way of delaying or even possibly preventing hip arthritis.” News stories should carefully evaluate such claims. In the April 2009 issue of Clinical Orthopaedics and Related Research, editor Richard Brand,MD, concludes a commentary by saying, “While current [hip arthroscopy] procedures clearly relieve pain and restore function and to a lesser degree restore motion in large portions of patients, we do not know whether these procedures will delay the development of osteoarthritis in middle age and beyond.” (Clin Orthop Rel Res 2009;467:605-7)
  • Sources: The story quotes two surgeons who perform a substantial number of hip arthroscopies. Testimony from a trusted independent source who is not an advocate would add balance.


Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not mention the cost of hip arthroscopy or other methods to treat labral tears and femoroacetabular impingement (FAI).

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

Not Satisfactory

The story provides no quantification of benefit. The anecdotal evidence of long-term benefit provided by one surgeon–that “hip arthroscopy may be a way of delaying or even possibly preventing hip arthritis”–is controversial, and viewed with skepticism by many experts. (Clin Orthop Rel Res 2009;467:605-7)

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

Not Satisfactory

The news story fails to mention potential harms of hip arthroscopy. A recent review suggests the rate of complications for all indications is “generally less than 1.5%.” (Clin Orthop Rel Res 2009;467:760-8) Various sources suggest complications include: scuffing of the articular cartilage and chondral surface from instrument breakage and inadequate distraction (separation of the femoral head from the hip socket); iatrogenic dislocation; nerve damage (sciatic, superior gluteal, lateral femorocutaneous); removal of too much labral tissue; removal of too much bone, thus weakening the bone and causing a fracture; damaging the blood supply to the femoral head, leading to avascular necrosis; temporary numbness of the perineum or foot (a distraction neuropraxia); and scrotal necrosis. Although an expert says that the procedure is meant to prevent future arthritis, this is not quantified; without good data on people who did not have the procedure, it is conceivable that arthroscopy could promote arthritis.

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

Not Satisfactory

The story does not mention any evidence or attempt to describe the quality of the scientific literature on this topic. A recent systematic review described the quality of the literature in this area as “limited.” The authors found no clinical trials and no studies with a prospective design that investigated treatment for labral tears and femoracetabular impingement. (Arthroscopy 2008;24:1135-45) The story does note that imaging is unreliable, and suggests that some doctors can make the diagnosis in spite of these limitations. But recent reviews have pointed out that the standard diagnostic techniques used today are not reproducible and can not accurately or consistently identify the source of pain in people with hip complaints. (Clin Orthop Rel Res 2009;467:666-75; Arthroscopy 2008;24:1013-18)

Does the story commit disease-mongering?


Hip pain can be very uncomfortable and occasionally disabling. The story does not over hype the problem or medicalize a normal human variation. Although it suggests that labral tears “can lead to osteoarthritis,” it doesn’t provide a complete picture of the natural history: do the symptoms ever go away on their own, even if the pathology doesn’t? In addition, there is no mention of how common the problem is and how many of these procedures are now being performed.

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

Not Satisfactory

The story includes interviews with two surgeons who perform a substantial number of hip arthroscopies. But the story should also include testimony from a trusted independent source who is not a proponent.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story briefly mentions rest and physical therapy, and implies that they do not work, but it is hardly a balanced discussion. Also, the story does not mention open surgical procedures, the historical “gold standard,” which can also restore the normal clearance that separates the femur and hip socket. There is no discussion of the relative benefits of the newer procedure compared with the options–and no mention that there do not appear to be any clinical studies comparing treatments.

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


The news story explains that orthopaedic surgeons are performing increasingly more hip arthroscopy procedures, and are taking increasingly more courses to learn how to do them. Readers are likely to correctly infer that the procedures are commonplace in some centers around the U.S. and less common in others.

Does the story establish the true novelty of the approach?


The story provides accurate information on the novelty of the treatment and its growth in popularity over the past 15 years.

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


The story cites two sources and does not appear to rely solely or largely on a news release.

Total Score: 4 of 10 Satisfactory


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