This news brief tells the story of a single patient who has a happy outcome after ankle replacement. It accurately describes the cost, availability, novelty, and some of the potential harms of the operation. But the story runs out of steam when it comes to assessing the evidence. Armed only with the testimony of one podiatrist newly trained to do the surgery, the article neglects to characterize the larger body of scientific evidence on ankle replacement for traumatic injures or osteoarthritis. And limited by the endorsement of just one patient, the article fails to quantify the benefits of the operation in a large population of people suffering with similar problems. Is this patient’s experience typical? What do cohort studies show? Are there other treatments that might help? (See “Treatment Options” above.) Are there randomized trials comparing ankle replacement to other treatments? Is there high-quality evidence to suggest any intervention provides a satisfactory outcome over the long run? Regrettably, these questions remain unanswered.
The implication of stories such as this is that when there is nothing to lose, people should be willing to subject themselves to the potential harms of something new. The story would have been helped by a simple declaration that there is no evidence currently available to help patients weigh the risks and benefits of this operation.
The article says that the full charge for the operation is about $45,000, which insurance companies may negotiate down to about $25,000.
The news article chronicles one patient’s experience before and after ankle replacement surgery. Though the patient reports that she now walks “100 percent better,” the story makes no attempt to quantify the benefits in a reliable, scientific manner.
The news story mentions harms and potential disadvantages of ankle replacement, including infection, tissue scarring that could limit the ankle’s range of motion, and failure requiring a fusion operation. However, the article doesn’t mention that because this device is new, no one truly knows the range of risks or how common they are when used in routine practice. This is a critical piece of context that is lacking in the story.
The article fails to characterize the evidence to support ankle replacements as a treatment for traumatic injures or osteoarthritis. Instead it relies entirely on the testimony of a podiatrist who has taken a training course sponsored by the ankle implant’s manufacturer. What do cohort studies show? Are there randomized trials comparing ankle replacement to other treatments? These questions remain unanswered. The story could have simply stated: "There is little published information from patients who have undergone this procedure, so its safety and effectiveness are unknown."
The article describes a woman who injured her ankle in an accident more than 15 years ago. The article clearly implies that this device is only considered for the unfortunate few.
The story relies exclusively on the testimony of a single surgeon as the expert source. It mentions his association with the manufacturer of the ankle implant, but it does not attempt to balance his enthusiasm or that of his patient with the assessment of an independent source.
In addition to ankle replacement, the story mentions fusion and ankle braces as other ways to treat ankle pain and disability, and rightly implies that they have a longer track record. There are a variety of other options for patients whose symptoms are caused by trauma or osteoarthritis. Some patients with arthritis report short-term pain relief with hyaluronic acid injections (Clin Podiatr Med Surg 2005;22:585-97, vii.). Additional surgical procedures reported to relieve pain and improve function include ankle joint debridement (J Bone Joint Surg Br 2001;83: 9-13), joint distraction (Arthritis Rheum 2002;46:2893-902), and implantation of cultured cells (Osteoarthritis Cartilage 2005;13:601-7) or bone-cartilage plugs (Arthroscopy 2005;21:159-66). However, few high-quality studies have shown patients to be consistently satisfied with any treatment over the long term.
The article suggests that the ankle replacement is not yet widely available, and focuses on one of the first people in central Iowa to undergo the procedure.
The story explains that ankle replacements “are rarer” than hip and knee replacements, rightly implying that they are still a relative novelty. It also mentions that there have been previous devices that did not provide longterm benefit.
We can’t be sure if the story relied solely or largely on a news release, although it did rely on the input of just one podiatrist at just one hospital regarding just one patient.