This story describes a minimally invasive procedure using bone cement that may offer pain relief to people suffering from some forms of knee and hip arthritis. The key word being “may.”
The story did a good job of explaining the procedure, and included some critical comments from a source, but these points were thrown off balance by quite a few shortcomings. How much does it cost? How well does it work? What are the risks? What research has been done? The reader will be left with an incomplete picture.
When it comes to an up-and-coming procedure like this, it’s buyer beware. Major clinical trials are needed before we have a good idea of how well it works–and how risky it is. To help patients make informed decisions, news stories must make this very clear.
The story did not mention any cost-related concerns. The story posits that this procedure is less invasive than the standard joint replacement surgery, which suggests there would be cost savings associated with pursuing a “bone cement” or “subchondroplasty” procedure, but this is not explicitly stated in the story. Also, like any new medical treatment, the cost might be much higher than expected.
Beyond serving as a “less invasive,” outpatient alternative to joint replacement surgery, there was no discussion about how to quantify these benefits.
The only harm mentioned in the story is the harm of overselling the benefits of the procedure. There is no discussion of whether there are other significant harms to consider. Like all surgery, this procedure will have serious risks–both within the joint that’s being injected and throughout the body. (A similar injection into the spinal vertebrae, called vertebroplasty, comes with very serious potential risks.)
This story does not include sources of evidence beyond interviews with physicians. There is no description of how the procedure has worked when it has been evaluated in a research setting. It is not clear from this story whether this procedure is being offered on an experimental basis with only case studies reported or whether there may be an emerging body of higher quality evidence supporting its use for some patients. Higher quality evidence would include large observational studies or randomized controlled trials.
To its credit, the story included this quite: “The claims that are being made are not evidence-based yet, although they are intellectually appealing.”
Arthritis is a common concern for many, and this story does not distort the impact it can have on people’s lives.
One thing to note: Arthritis is typically associated with aging, and the quote from one recipient of the bone cement procedure that he feared having a “a fake hip in there at the age of 30” confuses this issue, since it is rare for a young adult to have advanced arthritis that would require joint replacement surgery.
Two doctors and one patient served as sources of information for this news story. One of the doctors gave important commentary on the lack of evidence, which was good. However, according to Dollars for Docs, both doctors have received money from orthopedic device makers, some of which make products for this procedure. That should have been disclosed.
This story introduces two approaches to managing arthritic pain for patients: joint replacement surgery and the bone cement outpatient procedure. The story mentions that the procedure is not appropriate for people with severe (“bone-on-bone”) arthritis, but is directed at people with thin cartilage and mild arthritis. In standard clinical practice, joint replacement surgery is reserved for end-stage, debilitating arthritis. More appropriate comparison treatments for mild arthritis would include physical therapy and over-the-counter medicines. We do not learn from this story how the pain relief or functional improvements of bone cement compare to these typical conservative therapies. It’s unclear whether or not this procedure has any place compared to standard treatment.
Bone cement procedures seem to be widely available for vertebral compression fractures, but it is not clear from this story or an internet search whether access to a bone cement procedure for knee and/or hip pain is still very limited or relatively accessible.
The story started to describe the novelty here:
“The procedure, called subchondroplasty, has been available to people with knee problems for years, Vasileff said. Now he and his colleagues are testing to see whether hip patients also can benefit from it.”
Yet, it never follows up with discussion of said testing: Is it a clinical trial?
The story included sources not affiliated with the news release.