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Speaker: Evidence, data, outcomes will guide next generation of hip surgeons
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The presidential guest speaker at the Hip Society Specialty Day Meeting in Las Vegas said data, new ways to examine evidence and the ways surgeons use surgical outcomes will ultimately shape the future of hip arthroplasty and drive new innovations in the field.
Fares S. Haddad, BSc, MCh (Orth), FRCS (Orth), FRCS (Ed), discussed the evolving field of hip surgery; the future of the hip arthroplasty procedure, which he described as “the greatest operation that has ever been invented;” and why it is essential that orthopaedic surgeons deliver safe treatments and care that is cost-effective.
“We face a different world now. Patients demand normality. They do not want just pain relief. Sadly, they are encouraged to expect results that are not realistic. At times we get waylaid. Perhaps our focus needs to be on safe care, cost-effective care and on ensuring that this wonderful operation is available to everyone who needs it worldwide,” Haddad, an Orthopaedics Today Europe Editorial Board Member, said.
Innovation driving THA advances
Innovation can no doubt advance the field of joint replacement, but sometimes the most minor change can lead to mishaps, Haddad said. When things go wrong, he warned against looking for new innovations for problems in the field “rather than returning to something that is established, safe and has worked for generations.”
In addition, he said patient-derived data will be critical in the future. How the data are organized and how surgeons use that information to refine new procedures and products and expand the indications for hip arthroplasty will be key.
According to Haddad, registries are a fantastic source of data. He said they should be utilized by every orthopaedic surgeon because physicians who do not track their clinic’s results or their patients’ outcomes will eventually be unable to compete with those who do. The data in registries should be validated and should not be over-interpreted, as they are only observational data and cannot prove causation.
A profession united
“As a profession, there is no doubt we need to come together, correlate our data and use those data to effectively move forward. Otherwise, we are in danger of outsiders using inferior data that were not designed for the purpose of defining the future of hip surgery, and imposing undesirable pathways for us and our patients. It is critical we do that,” Haddad said.
The most important thing is to do what is best for a patient’s health and what will give them the best outcomes. This is a simple tenet, according to Haddad, but outside pressures may affect the surgeon’s decision-making process or blind the surgeon to key factors.
“In a decision-making process, as a surgeon, we look at the literature. We have got our patient. We are under pressure from the media, from the industry, and we are under pressure from our management and the government. That creates massive conflict we have to deal with. The decision-making philosophy within the surgeon — it really does need to focus every time on what is best for the patient, and it demands active thought, integrity and an ability to manage conflicts,” he said.
New is not always best
Haddad said surgeons must understand not everything new is useful, and not everything mandated by politicians is helpful in the field of medicine or is the best option for patients.
“We need to maintain a system to innovate, but do it safely. One of my key messages is: Not everyone can innovate. We need to choose structured settings where people know where they start, where they want to see improvement and why, and change one thing at a time. It is not for everybody and not everybody can do it,” Haddad said. – by Robert Linnehan
- Reference:
- Haddad FS. Innovation, decision making and the evaluation of outcomes in hip surgery. Presented at: Hip Society Specialty Day; March 28, 2015; Las Vegas.
- For more information:
- Fares S. Haddad, BSc, MCh (Orth), FRCS (Orth), FRCS (Ed), can be reached at University College London Hospitals NHS Trust, 44 Arkwright Rd., London NW3 6BH, United Kingdom; email: fsh@farehaddad.net.
Disclosure: Haddad reports no relevant financial disclosures.