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- Talk
- 21/09/2022
- UK
What Can 723,904 Hip Replacements Tell Us About The Best Approach For The Hip?
Description
The presentation given by Michael Whitehouse delves into the complexities of evaluating surgical approaches in hip replacement procedures. Whitehouse likens their study to the 'ugly duckling' of research, addressing the challenges presented by randomized controlled trials (RCTs) and the conflicts that arise when funding sources influence research outcomes.
Whitehouse emphasizes the collaborative nature of research and invites audience engagement by referring to a BMC Medicine paper that details their findings. He discusses the effectiveness and longevity of hip replacements while questioning the necessity and practicality of trials in this well-established procedure, citing challenges from Health Technology Assessment (HDA) authorities who deem it not a significant concern.
The presenter highlights a meta-analysis yielding insufficient results despite numerous studies, emphasizing the limited sample sizes involved. He shares insights from his past work regarding mortality and infection rates linked to surgical techniques, leading into their current research on total hip replacement for osteoarthritis over nearly 14 years, which included extensive data from over 720,000 primary surgeries.
Whitehouse outlines his findings on various surgical approaches, noting the complexities introduced by changing definitions and data interpretations. He presents statistical analyses, such as proportional hazards and logistic regression, to unpack the nuances of complications and patient outcomes.
The results show that posterior approaches yield lower revision rates and complications compared to minimally-invasive anterior and lateral methods, with a concerning increase in mortality associated with lateral approaches. Ultimately, he advocates for the well-documented posterior approach, highlighting its safety and training benefits, and suggesting that patients deserve to be informed about surgical risks involved in less common alternatives. The presentation concludes with gratitude towards patients and data contributors.