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Boston Globe overlooks evidence showing many patients not helped by ‘bionic’ joint replacements


3 Star


Boomers are going bionic, and they want joint replacements to let them do it all

Our Review Summary

This story reported on the growing popularity of joint replacement surgery, which it said is driven by Baby Boomers who want to take advantage of improving technology to regain their active lifestyles.

To its credit, the story addressed costs, highlighted overly optimistic expectations by patients, and mentioned the generous incomes of surgeons who perform these operations. Yet, in some parts of the story, it reads like an advertisement for joint replacements and for the doctors and hospitals that perform them, compounded by futuristic terminology like “bionic.”

This was amplified by the lack of specific data on benefits for patients, and the only expert quoted has a conflict of interest that wasn’t disclosed. The story also could have mentioned evidence that many joint replacements don’t do much good.


Why This Matters

The estimated global market for joint replacement is $16 billion, with most of that spent in the U.S. However, there’s evidence that many of these procedures aren’t providing much benefit for the people who get them, so restraint is warranted in reporting about these invasive and costly procedures.


Does the story adequately discuss the costs of the intervention?


The story states: “The procedures can cost up to $50,000 for knees and $40,000 for hips, though the prices vary widely among Medicare and private insurers, which typically bear the bulk of the cost.”

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

Not Satisfactory

The story offered several positive anecdotes, such as a former mountain climber and football player who resumed his ability to hike and run on a treadmill after two knee replacements.

But there was little data.

It would have been much better to quote an objective research study about knee and hip replacements and to present real estimates of these patient-reported outcomes.

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


The story mentioned at least some potential harms:

In patient-reported surveys, some still complain of pain and tissue inflammation after their procedures. Smaller numbers suffer serious complications, ranging from blood clotting to hospital-acquired infections.

Still, it could have devoted more attention to risks, including the lax regulation of implantable devices.

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

Not Satisfactory

The story offered some cautions, noting boomers “may have a tougher time coming to terms with the reality that a new body part doesn’t mean they can resume all of the high-impact activities that were a major part of their lives.

“Nobody will return to playing football,” (surgeon David) Mattingly said. “The person who struggles is the one who’s done long-distance running for years and just doesn’t want to give it up.”

But the story could have given more caveats. For example, an analysis funded by a government-industry initiative concluded that total knee replacements for patients with osteoarthritis had “minimal effects on quality of life” and may be warranted only for those with more severe symptoms.

The story also reported that implants “don’t wear down as fast as they once did” and have a “90% chance of lasting two decades,” but no evidence was cited. Some research has questioned the safety and efficacy of new hip and knee implants, and that wasn’t mentioned.

Does the story commit disease-mongering?

Not Satisfactory

The story ignored a body of evidence showing many patients who receive joint replacements don’t get much benefit, including a recent report that found one in four joint replacements in Australia weren’t needed.

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

Not Satisfactory

The story admirably reported the generous pay of doctors who do joint replacements: “Last year, the average salary for joint-replacement specialists topped $575,000, reported the Dallas consulting firm Merritt Hawkins & Associates, compared with just over $230,000 for family doctors.”

But the story doesn’t tell readers that the only doctor it quotes — orthopedic surgeon David Mattingly, M.D. — has received $160,000 from joint maker DePuy Synthes, a division of Johnson & Johnson, in recent years, according to the database Open Payments.

It would have been good to quote a doctor who doesn’t make a living doing these surgeries (e.g. an internist or sports medicine doctor who treats hip and knee osteoarthritis).

Does the story compare the new approach with existing alternatives?

Not Satisfactory

There was no mention of alternatives such as cartilage restoration procedures to stabilize joints, losing weight to ease joint strain, and managing activity to avoid injury.

Treatment of hip and knee osteoarthritis is a classic example of a “shared decision” that should be made based on patient preference because there is no “right” answer – joint replacement is often no better than physical therapy, for example, but this did not come across at all in the piece.

Here’s an example of a decision aid for hip and knee osteoarthritis.

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


The story made it clear that knee replacements are widely available and covered by insurers.

Does the story establish the true novelty of the approach?


The story said “joint implants have become more customized to suit individual patients, but a Billerica company is pushing the personalization trend further. ConforMIS Inc. uses 3-D printing and imaging software to more precisely tailor replacement joints.”

This seems to be a new trend although we weren’t able to find any independent research about whether customization leads to better for patients.

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


The story did not appear to rely on a news release.

Total Score: 5 of 10 Satisfactory


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