Tuesday, October 2, 2012

Metal-On-Metal Hip Implants-a Technology Overview by the American Academy of Orthopaedic Surgeons ( 1 of x)


[What I found interesting about this:
  • Both the British and Australian agencies have published very specific guidelines on the monitoring of patients with this hip  monitoring and the approach the US surgeons took was to conduct an 80 page review with raw data and charts  with the only guidance being:
"Patient care and treatment should always be based on a clinician's independent medical judgement given the individual patient's clinical circumstance."

How many orthopedic surgeons are gonna read this and even if they did, the clinical guidance leaves much to the imagination!!   ......because there isn't any!

In any discipline, there are a few at the top of the organization who  understand this kind of   new data and what they might do with it.  80% don't.  I wonder why, the organization's leaders don't understand that absent guidance, the surgeons are left with their hunches to guide them....and I might add, they have little experience and knowledge about what the heck they are supposed to do.  What was the word my orthopedic surgeon used a year ago when I asked him proactively what I should do based on my readings....?  His reponse:  "It's all very murky."  Sure as hell is and this organization needs to step up to the plate to provide something to help thier members out.

I think this is a real problem.  It is clear to me that the people who are providing the information don't see the problem with their troops.  I also think thier troops are in desperate need of guidance and likely, if they asked the troops, they would hear the need for guidence.

I think I will take my surgeon the British and Australian recomendations so he has something to go think about.   And I might add, I think I have a really smart surgeon.  He  graduated from the Ivys in both medical school and undergraduate and is quite bright.  What about the rest of these guys?

I will run a series on some of the data in this report.  While I am familiar with the data in general, it is always interesting to see the aggregate data summarized and categorized into which studies and data are relevant and which are not....from a scientific perspective.

Since this is  an 80 page  PDF, sorry but I will have to snip things out  I think are interesting from the report.

In any event, it is a very well reviewed compilation of all of the studies on this subject which I believe they said was about 3038 hip citations and data from 8 joint registries that were potentially relevant to this overview.  They only used 19 articles and the data from 2 joint registries out of all of these studies though.  They were the ones  that met thier inclusion criteria to address the questions above.  Obviously, there is a lot of low quality data and studies out there!  They said they used the following as inclusion criteria:
  • study design
  • study quality (how well the study was conducted or executed)
  • the quality of the statistical analysis
The bottom line of the whole thing is that they concluded that the current studies do not allow them to determine whether one type of patient fares better than others with these MoM hips.....AMAZING ISN'T IT?  Just think about this.  I think this says that out of the thousands of published journal articles only a handful met their criteria for sound studies!!!!  Yikes!  What does this say about the plethora of journal studies that are published on this subject???

British recomendations can be found here: http://www.blogger.com/blogger.g?blogID=812589698208872122#editor/target=post;postID=5069703744367497835

The Australian recomendations can be found here:  http://www.blogger.com/blogger.g?blogID=812589698208872122#editor/target=post;postID=6840861103927847683

US FDA recomendations can be found here: http://www.mydepuyhiprecall.com/search?q=FDA+recomendations+for+the+metal+hip+patients

I think they are both helpful and practical for surgeons who have no time to really look at the literature.

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