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.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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