Hamilton doctor questions effectiveness of ‘expensive’ hip arthroscopic surgery

News Mar 21, 2016 by Joanna Frketich The Hamilton Spectator

"Is hip arthroscopic surgery a sham?"

That question at the top of a press release March 10 was the beginning of vastly conflicting accounts of what is taking place in a Hamilton-led study involving 54 patients to date put under general anesthetic at McMaster University Medical Centre.

But it was also the question that started the ongoing Femoroacetabular Impingement RandomiSed Controlled Trial (FIRST) to begin with.

A surgery to treat a painful condition where there is a mismatch of the ball and socket in the hip joint had caught the attention of Dr. Mohit Bhandari. The leading orthopedic researcher is a member of McMaster University's Clarity Group, which advances evidence-based medicine.

Evidence was what appeared to be lacking in the minimally-invasive procedure being done by Dr. Olufemi Ayeni — one of a handful of Canadian doctors performing Femoroacetabular Impingement (FAI) surgery involving shaving bone and repairing torn tissue.

"Why do you think this works?" Bhandari describes asking the surgeon in an interview.

Ayeni's reported reply: "I trained under world experts in the U.S. and they do this procedure all the time."

In fact, the number of FAI surgeries doubled between 2008 and 2014 in the United States.

"It has been explosive on how much popularity it has had in the last five years," described Bhandari during an interview. "In Canada, it costs the health care system. In the U.S. it generates a lot of revenue for hospitals because it's a fairly expensive procedure."

But it hasn't been proven in randomized controlled trials because most of the doctors who do the surgery believe so strongly it works that it would be unethical for them to withhold it from a group of patients in a study.

"I couldn't in good conscious," said Dr. Derek Ochiai, who does FAI surgery at the Nirschl Orthopedic Center in Arlington. "I've seen so much quantitative improvement in patients' range of motion … I truly believe the surgery is beneficial."

Bhandari doesn't have the same faith in FAI surgery and teamed up with Ayeni to do a study of 220 patients in Canada, Finland and Denmark.

"In medicine across history we have relied on faulty gut feelings from many experts in the past around what they think works and unless we experimentally test them we'll never know the true answer."

The best way to determine if FAI surgery is effective is to test it against a placebo, which leaves out the key therapeutic element of the treatment.

"In this case, patients will undergo the procedure as usual, but those who receive the placebo surgery will have a cut in the hip, a small camera (scope) inserted and the joint washed out with saline water," said Bhandari in an email. "Those having the FAI surgery will also have a scope placed into the hip to repair torn tissues and shave away bits of bone that are believed to be causing pain. The recovery of both groups is then tracked."

Bhandari's account that half of patients will simply have their joint washed out with saline water matches numerous published accounts including a listing by the main funder, the Canadian Institutes of Health Research, which gave just over $200,000.

But it's not what Ayeni and another surgeon involved in the study say they're actually doing. Denying it is a placebo, Ayeni says tissue is repaired in every surgery.

A placebo is also not what patients were promised. They were told they'd get a treatment that is "acceptable and within the current standards of care" on the consent form they signed.

It has left mounting questions about what the study is actually testing.

"The study — FIRST — is … evaluating two treatment methods," says a statement by McMaster, Hamilton Health Sciences and the two researchers.

That description is a long way off from the one Bhandari gave in that first McMaster press release.

"The trial will aim to carefully test the effect of hip arthroscopy against a placebo procedure and determine, once and for all, whether the exponential rise in hip scope procedures has a scientific basis and true benefit to patients."

Patients in the FIRST trial can contact 905-526-3349 or jfrketich@thespec.com.

jfrketich@thespec.com

905-526-3349 | @Jfrketich

Hamilton doctor questions effectiveness of ‘expensive’ hip arthroscopic surgery

News Mar 21, 2016 by Joanna Frketich The Hamilton Spectator

"Is hip arthroscopic surgery a sham?"

That question at the top of a press release March 10 was the beginning of vastly conflicting accounts of what is taking place in a Hamilton-led study involving 54 patients to date put under general anesthetic at McMaster University Medical Centre.

But it was also the question that started the ongoing Femoroacetabular Impingement RandomiSed Controlled Trial (FIRST) to begin with.

A surgery to treat a painful condition where there is a mismatch of the ball and socket in the hip joint had caught the attention of Dr. Mohit Bhandari. The leading orthopedic researcher is a member of McMaster University's Clarity Group, which advances evidence-based medicine.

Evidence was what appeared to be lacking in the minimally-invasive procedure being done by Dr. Olufemi Ayeni — one of a handful of Canadian doctors performing Femoroacetabular Impingement (FAI) surgery involving shaving bone and repairing torn tissue.

"Why do you think this works?" Bhandari describes asking the surgeon in an interview.

Ayeni's reported reply: "I trained under world experts in the U.S. and they do this procedure all the time."

In fact, the number of FAI surgeries doubled between 2008 and 2014 in the United States.

"It has been explosive on how much popularity it has had in the last five years," described Bhandari during an interview. "In Canada, it costs the health care system. In the U.S. it generates a lot of revenue for hospitals because it's a fairly expensive procedure."

But it hasn't been proven in randomized controlled trials because most of the doctors who do the surgery believe so strongly it works that it would be unethical for them to withhold it from a group of patients in a study.

"I couldn't in good conscious," said Dr. Derek Ochiai, who does FAI surgery at the Nirschl Orthopedic Center in Arlington. "I've seen so much quantitative improvement in patients' range of motion … I truly believe the surgery is beneficial."

Bhandari doesn't have the same faith in FAI surgery and teamed up with Ayeni to do a study of 220 patients in Canada, Finland and Denmark.

"In medicine across history we have relied on faulty gut feelings from many experts in the past around what they think works and unless we experimentally test them we'll never know the true answer."

The best way to determine if FAI surgery is effective is to test it against a placebo, which leaves out the key therapeutic element of the treatment.

"In this case, patients will undergo the procedure as usual, but those who receive the placebo surgery will have a cut in the hip, a small camera (scope) inserted and the joint washed out with saline water," said Bhandari in an email. "Those having the FAI surgery will also have a scope placed into the hip to repair torn tissues and shave away bits of bone that are believed to be causing pain. The recovery of both groups is then tracked."

Bhandari's account that half of patients will simply have their joint washed out with saline water matches numerous published accounts including a listing by the main funder, the Canadian Institutes of Health Research, which gave just over $200,000.

But it's not what Ayeni and another surgeon involved in the study say they're actually doing. Denying it is a placebo, Ayeni says tissue is repaired in every surgery.

A placebo is also not what patients were promised. They were told they'd get a treatment that is "acceptable and within the current standards of care" on the consent form they signed.

It has left mounting questions about what the study is actually testing.

"The study — FIRST — is … evaluating two treatment methods," says a statement by McMaster, Hamilton Health Sciences and the two researchers.

That description is a long way off from the one Bhandari gave in that first McMaster press release.

"The trial will aim to carefully test the effect of hip arthroscopy against a placebo procedure and determine, once and for all, whether the exponential rise in hip scope procedures has a scientific basis and true benefit to patients."

Patients in the FIRST trial can contact 905-526-3349 or jfrketich@thespec.com.

jfrketich@thespec.com

905-526-3349 | @Jfrketich

Hamilton doctor questions effectiveness of ‘expensive’ hip arthroscopic surgery

News Mar 21, 2016 by Joanna Frketich The Hamilton Spectator

"Is hip arthroscopic surgery a sham?"

That question at the top of a press release March 10 was the beginning of vastly conflicting accounts of what is taking place in a Hamilton-led study involving 54 patients to date put under general anesthetic at McMaster University Medical Centre.

But it was also the question that started the ongoing Femoroacetabular Impingement RandomiSed Controlled Trial (FIRST) to begin with.

A surgery to treat a painful condition where there is a mismatch of the ball and socket in the hip joint had caught the attention of Dr. Mohit Bhandari. The leading orthopedic researcher is a member of McMaster University's Clarity Group, which advances evidence-based medicine.

Evidence was what appeared to be lacking in the minimally-invasive procedure being done by Dr. Olufemi Ayeni — one of a handful of Canadian doctors performing Femoroacetabular Impingement (FAI) surgery involving shaving bone and repairing torn tissue.

"Why do you think this works?" Bhandari describes asking the surgeon in an interview.

Ayeni's reported reply: "I trained under world experts in the U.S. and they do this procedure all the time."

In fact, the number of FAI surgeries doubled between 2008 and 2014 in the United States.

"It has been explosive on how much popularity it has had in the last five years," described Bhandari during an interview. "In Canada, it costs the health care system. In the U.S. it generates a lot of revenue for hospitals because it's a fairly expensive procedure."

But it hasn't been proven in randomized controlled trials because most of the doctors who do the surgery believe so strongly it works that it would be unethical for them to withhold it from a group of patients in a study.

"I couldn't in good conscious," said Dr. Derek Ochiai, who does FAI surgery at the Nirschl Orthopedic Center in Arlington. "I've seen so much quantitative improvement in patients' range of motion … I truly believe the surgery is beneficial."

Bhandari doesn't have the same faith in FAI surgery and teamed up with Ayeni to do a study of 220 patients in Canada, Finland and Denmark.

"In medicine across history we have relied on faulty gut feelings from many experts in the past around what they think works and unless we experimentally test them we'll never know the true answer."

The best way to determine if FAI surgery is effective is to test it against a placebo, which leaves out the key therapeutic element of the treatment.

"In this case, patients will undergo the procedure as usual, but those who receive the placebo surgery will have a cut in the hip, a small camera (scope) inserted and the joint washed out with saline water," said Bhandari in an email. "Those having the FAI surgery will also have a scope placed into the hip to repair torn tissues and shave away bits of bone that are believed to be causing pain. The recovery of both groups is then tracked."

Bhandari's account that half of patients will simply have their joint washed out with saline water matches numerous published accounts including a listing by the main funder, the Canadian Institutes of Health Research, which gave just over $200,000.

But it's not what Ayeni and another surgeon involved in the study say they're actually doing. Denying it is a placebo, Ayeni says tissue is repaired in every surgery.

A placebo is also not what patients were promised. They were told they'd get a treatment that is "acceptable and within the current standards of care" on the consent form they signed.

It has left mounting questions about what the study is actually testing.

"The study — FIRST — is … evaluating two treatment methods," says a statement by McMaster, Hamilton Health Sciences and the two researchers.

That description is a long way off from the one Bhandari gave in that first McMaster press release.

"The trial will aim to carefully test the effect of hip arthroscopy against a placebo procedure and determine, once and for all, whether the exponential rise in hip scope procedures has a scientific basis and true benefit to patients."

Patients in the FIRST trial can contact 905-526-3349 or jfrketich@thespec.com.

jfrketich@thespec.com

905-526-3349 | @Jfrketich