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Ankles Gain as Candidates for Joint Replacement


2 Star

Ankles Gain as Candidates for Joint Replacement

Our Review Summary

This article reviews ankle joint replacement, a relatively uncommon procedure, when compared with knee or hip replacement.  This topic is of interest as ankle replacement surgery is a procedure that may be unknown to many readers.  A graphic and overview of an ankle replacement is provided below.  This story provides a general overview of the topic including risks and benefits.  However, the lead-in should have been more specific to clarify that knee and hip replacement are most often associated with osteoarthritis, the most common form of arthritis, while ankle replacement is largely performed in patients with post-traumatic osteoarthritis and the much less common rheumatoid arthritis.  This story provides very little scientific evidence or independent expert testimony to support the information provided.   In addition, the main expert interviewed has a financial relationship with the company that produces the implant he uses.  It is possible that this creates an incentive to use this procedure more and to describe it in a more positive light. This story also has other omissions and inaccuracies including the cost of the procedure and that 5, not 4, devices are FDA approved.


Why This Matters

This is a relatively uncommon procedure that many readers may not be aware of.  Unfortunately this column didn’t do the best job of presenting the information in a complete and balanced manner. 


Does the story adequately discuss the costs of the intervention?

Not Satisfactory

This article does not discuss costs – a significant oversight.

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

Not Satisfactory

Potential benefits including, decreased pain, improved physical function and quality of life, are mentioned – but no data is provided.  How often do these occur?  That’s a pretty important piece of information for readers.

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


The story presents some risks, i.e. replacement failure, loosening, slow healing, infection and amputation.  It also mentions that not all individuals are appropriate candidates for surgery.  It could have provided numbers for how often these harms occur.  Nonetheless. we’ll give it the benefit of the doubt on this criterion and grade it barely satisfactory.

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

Not Satisfactory

No real concrete scientific evidence is presented in the story.  General points are made, such as the concern of failed surgery or loosening of the artificial joint; however, these points were not backed up by published data.  The article quotes an expert saying that 90% of ankle replacements last about eight and a half years.  A citation of this information would have been helpful to include.  Data suggests that these results may be applicable for a much shorter time frame on average and that the survival rate of implants may be quite variable. For example, one recent publication indicates that the 5 year implant survival rate is about 78% and that approximately 7% of implants require revision surgery within 5 years.

Does the story commit disease-mongering?

Not Satisfactory

Borderline.  The numbers fly fast and furious – "Each year about two million Americans visit the doctor for ankle pain from arthritis or fracture. An estimated 50,000 people a year experience end-stage ankle arthritis."  In framing the ankle as "fast becoming a candidate" for joint replacement, there is a whiff of disease-mongering in the air.  Given the sourcing on the story – all experts with potential conflicts of interest – we’re going to give this one a thumbs down.

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

Not Satisfactory

The story clearly indicates that all of the experts interviewed had ties to manufacturers of the joint implants.  While this may be expected due to the relatively small number of surgeons who perform this procedure, this is a clear example of conflict of interest.  The story should have included comment from an independent unconflicted surgeon or referring physician (non-surgeon) with no stake in this.  Disclosure is one thing; providing balance is quite another.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

This article correctly indicates that ankle fusion is the only surgical option to joint replacement.  Many experts consider ankle fusion to be a highly successful procedure that relieves pain for many patients despite some loss ankle flexibility.  A more detailed comparison of the procedures would have been informative to the readers. In addition, the story should have indicated that non-surgical options such as medication, physical therapy and orthotics, are the more common treatment approaches.

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


This story correctly notes that ankle replacement has been available for several decades but is not widely performed.  However, there was an omission in not indicating that that knee and hip replacement are most often associated with osteoarthritis, the most common form of arthritis, while ankle replacement is largely performed in patients with post-traumatic osteoarthritis and the much less common rheumatoid arthritis.   In addition, the article inaccurately states that 4 models are FDA approved.  A fifth model, the STAR, which has a unique design, was FDA approved in May 2009.

Does the story establish the true novelty of the approach?


This story highlights a procedure that may readers may not be aware of because it is not commonly performed although it has been available for some time. 

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


It does not appear that the article is based on a press release.

Total Score: 4 of 10 Satisfactory


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