Meeting evolving patient expectations by bridging the growing gap between researchers and clinicians

Over the past several decades, the collaborative efforts of surgeons, researchers and device manufacturers have resulted in the development of orthopedic implants and surgical techniques that have achieved an exceptionally high rate of success in the treatment of orthopedic conditions.

However, one of the key points of Dr. David Burr’s presidential address to the Orthopaedic Research Society (ORS), given this Tuesday, was his sense of a growing chasm between the research and clinical communities and his belief that the scientific discovery process is not attuned enough to the clinical scenarios faced daily by orthopedic surgeons.

He observed that, over the past 10 years, the stated missions of the ORS and the American Academy of Orthopaedic Surgeons (AAOS) have grown apart. As the AAOS became more involved in education for its members, the ORS became more cellular and molecular in its research mission, often not relating the scientific discoveries to the real, everyday problems of the orthopedic surgeon, Burr suggested.

There seems to be a disconnect between research and the needs of clinical practice. Some relevant examples of unmet needs in applied research include infection control and treatment, materials sensitivity and consistent device placement. More could be done in the ORS to address these real needs of the orthopedic community.

In hip and knee arthroplasty, it is clear that the patient population receiving devices is changing. A greater number of today’s orthopedic patients are younger and placing more demands on their implants. As with the general population in many developed countries, patient life expectancy and body weight is increasing, and there is a higher incidence of related comorbidities such as Type II diabetes. Even so, patients expect increased implant longevity and functionality or, ideally, early joint care intervention that may preclude — or at least substantially delay — the need for a joint replacement.

We note that despite 50 years of successful research and development in hip and knee arthroplasty, there are few published, long-term, clinical studies to clearly identify the specific needs and expectations of individual patients with regard to their implants. Furthermore, there are few studies showing correlations — or possibly the lack thereof — between a surgeon’s perception of clinical success and a patient’s satisfaction with the procedure.

The events of the last few days suggest the possibility that the current level of patient success is now so great that mere technological innovations are unlikely to provide substantial improvement. A concerted effort is needed by surgeons and researchers to explore patient expectations and patient performance on both a cohort and individual basis. This will require care, support and counseling throughout each phase of disease and the related treatment. In this way, it may be possible to more closely match the expectations of patients and physicians to outcomes.

In the final analysis, the goal of the researcher, the manufacturer and the clinician must be optimal treatment matched to the individual patient and to that patient’s expectations.

For more information:
Michael T. Manley, PhD, is academic director, Homer Stryker Center for Orthopaedic Education and Research, Mahwah, N.J. Jonathan Black, PhD, is professor emeritus at Clemson University and is the chair of the Scientific Advisory Board, Homer Stryker Center for Orthopaedic Education and Research, Mahwah, N.J.