Patients who suffer with hand and wrist arthritis face a number of treatment options, none of them especially good ones. This article attempts to show how one surgical procedure—the replacement of the wrist joint—fits into the spectrum of treatment choices. It notes that the “seldom-used” operation has been around for decades, and accurately reflects the complexity of the operation. Although the story mentions some of the alternatives to joint replacement (e.g. medications, physical therapy, and fusion)—and briefly sketches their advantages and disadvantages, it does not attempt to evaluate the quality of the evidence to support any of them. The story provides no data on whether the operation is appropriate in some people and not others, no measure or list of potential complications or costs, and no quantification of the procedure's absolute benefit or its relative worth compared to other treatments. The heart of the story is essentially a collection of anecdotes from one patient and one surgeon in one city in Texas. The article provides no news and little analysis, and largely reflects the story line of a recently issued press release from the institution where the surgeon performs these operations.
The article fails to mention the cost of treatment or whether it is covered by Medicare or other insurers.
There is no quantification of benefits. The story reports ony the anecdotal experience on one patient with one surgeon.
The article mentions a single disadvantage of the operation—that patients can’t lift heavy objects. But any patient undergoing joint replacement faces potential complications such as infection. In one recent study, 52% of patients had a complication after wrist replacement and 44% reported pain one to five years after surgery. (J Hand Surg [Am]. 2003;28:570-6). There is also the possibility of undergoing a second operation for fusion if the implant fails—a risk that persists with newer implant designs as well as old ones. The article does not cite a source for the projected 10- to 15-year life of the device.
There is no discussion of evidence, a major lapse. Readers should know that there is scant high-quality literature on wrist replacement. Some experts consider the procedure experimental. The story’s “evidence” is comprised mostly of testimonials of one patient who underwent the operation and one doctor who performs about 10 of the operations every year.
There are no obvious elements of disease mongering. It is clear that wrist replacement surgery is a treatment of "last resort."
The story relies on one patient and one “expert,” a surgeon who performs wrist replacements. It provides no information on potential conflicts of interest and no conflicting points of view. Input from experts outside of this institution would provide balance and potentially clarify the risks and benefits of this procedure.
The article outlines some alternatives to wrist replacement surgery (e.g. medications, physical therapy, and fusion)—and briefly sketches their advantages and disadvantages. There are other surgical treatments for wrist arthritis as well, though the evidence to support them is also sparse.
The article explains that wrist replacement has been available for decades. But why is the procedure “seldom used”? Is the device FDA-approved? Is the operation widely available in the U.S., offered in the local community hospital, or mostly consigned to large or academic medical centers? The article does not say.
The story points out that wrist replacement surgery has been around for decades. The story’s single source of medical information—a surgeon–suggests that newer versions of the implants enable surgeons to retain more of the patient’s native bone.
Two weeks before this story was published, the Texas Medical Center issued a press release about wrist replacement surgery, covering much of the same information in the Houston Chronicle article. The Medical Center is named in the second sentence of the article, and the story’s expert source is the same surgeon that is quoted in the press release. The story fulfills every public relations department’s dream, and does not stray far from the hospital’s and surgeon’s story line. But we can't be sure if the story relied solely or largely on the press release.