The AP news story does a nice job of explaining what hip resurfacing is and how it fits into the history of hip replacement procedures. It summarizes the current availability of hip resurfacing in the US. However, the story provides virtually no evidence on the efficacy of resurfacing to support the mostly glowing testimonials of the three surgeons it quotes. According to the news article, the FDA “cited studies showing the Birmingham Hip resurfacer lasted at least five years…” What sorts of studies did the FDA analyze? What about the rest of the outcomes that patients value—such as improvements in pain and activity? Are there any randomized trials that compare similar patients who have undergone resurfacing with patients who have undergone total hip replacement? Is there follow-up beyond five years? These questions remain unanswered. The discussion of harms is likewise incomplete. The news article points out that hip resurfacing isn’t for everyone, and mentions two groups in whom it might not be appropriate. But the available research suggests the picture may be more complicated. There is disagreement about whether the procedure impairs the blood supply to bone or generates so much heat that it could cause the death of thigh bone. Bone death (necrosis of the femoral head) is a devastating complication for which there is currently no good solution. Other studies suggest additional potential problems. (For references and more details on potential harms, see “Harms of Treatment” above.) Although it is true that some researchers have found few problems with the devices and reported great success, readers deserve to know where the uncertainties lie. Perhaps the greatest uncertainty has to do with how long the implants will hold up. Though sufficient for FDA approval, survival of “at least five years” is not a strong endorsement. Total joint replacement, by comparison, has a track record extending 15 to 25 years. A closer look at the evidence might have reshaped the take-home message from this news report.
No mention of costs. This is a substantial oversight. Experts say the implant alone costs four to five times as much as a traditional hip implant—about $12,000 versus $2500 to $3000.
The story provides no quantitative estimates of the benefits of hip resurfacing, nor any quantitative comparison with patients undergoing other treatments for hip arthritis.
The news article points out that hip resurfacing isn’t for everyone, and mentions two groups in whom it might be inappropriate—those with poor bone quality and others with kidney problems. But the recent literature on hip resurfacing suggests there are other concerns as well. There is disagreement about whether the procedure impairs the blood supply to bone. [J Bone Joint Surg Am. 2006 Nov;88 Suppl 3:84-9.] Some reports find a higher-than-usual fracture rate in the thigh bone. [J Bone Joint Surg Br. 2006;88:1652-3] Some worry about the increase in metal ions generated by two metal devices rubbing against each other. One study showed that heat generated during the procedure was high enough to cause the death of thigh bone. [J Bone Joint Surg Br. 2007;89:16-20.] This would be a devastating complication for which there is currently no good solution. (One treatment is total hip replacement.) In another study, researchers found that alignment changes could put patients at greater risk of impingement, “leading to abnormal wear patterns and pain.” [J Bone Joint Surg Br. 2007;89:9-15.] Although it is true that other researchers have found few problems with the devices and reported great success, readers deserve to know where the uncertainties lie. Perhaps the greatest uncertainty has to do with how long the implants implants will hold up—a significant shortcoming in the evidence for a device designed to substitute for total joint replacements with relatively successful track records as long as 15 to 25 years.
The article is built largely around the testimonials of orthopedic surgeons who view hip resurfacing as a favorable development. In the final sentence the story takes a stab at establishing the evidence for the treatment – citing the FDA – but it is too little too late. According to the news article, the FDA “cited studies showing the Birmingham Hip resurfacer lasted at least five years…” What sorts of studies did the FDA analyze? What about the rest of the outcomes that patients value—for example, improvements in pain and activity? Are there any randomized trials that compare similar patients who have undergone resurfacing with patients who have undergone total hip replacement? Is there follow-up beyond five years?
Hip resurfacing is designed to treat a very real problem—pain and activity limitations caused by osteoarthritis in relatively young individuals.
The news article cites three orthopedic surgeons, including one who is a spokesperson for the leading orthopedic medical society in the U.S. But the story provides no information about their potential conflicts of interest. Because many surgeons have consulting contracts and other agreements with device makers, this is important information.
The story rightly explains that total hip replacement is the major alternative to hip resurfacing. Although it explains why resurfacing may be better than total hip replacement, it does not say much about the potential disadvantages of resurfacing—most prominently, its brief track record. This information is vital if readers are to compare the new idea with existing alternatives. Young, active readers might also want to know about nonsurgical alternatives for arthritic hips. These include strengthening, exercise, physical therapy, and pain medications.
The article states that the first hip resurfacing system was approved by the FDA last spring and that competitors’ systems are in trials. It also notes that few orthopedic surgeons are trained in this procedure in the U.S.
The AP news story does a nice job of explaining what hip resurfacing is and how it fits into the history of hip replacement procedures.
Because the story relied on several different sources, it does not appear to have relied solely or largely on a news release.
Comments
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.