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Speaker addresses the changing evidence base in pediatric orthopaedics
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What was considered dogma in pediatric orthopaedics nearly 4 decades ago may now be considered misinformation, Stuart L. Weinstein, MD, said during the EFORT Michael Freeman Honorary Lecture. This, he said, is why continued research is needed to determine which treatments and procedures are still effective.
“The lecture I gave was a summation of the work I have done over the last 38 years at the University of Iowa to establish an evidence base for what we do in pediatric orthopedics. Basically, in health care today, people are not going to pay for everything you do. They want to pay for value; they want to pay for things that work,” Weinstein told Orthopaedics Today Europe. “The fundamental foundation for paying for value is evidence based medicine. To have evidence-based medicine in orthopaedics you need to know the natural history and adult outcomes of untreated patients with pediatric orthopaedic conditions.”
Changes over time
Weinstein, who is past president of the American Academy of Orthopaedic Surgeons, stressed that common treatments in pediatric orthopaedics need to be examined and researched to see if they work long term, or if they change natural history. Many children react well to treatments in the short term, he said, but it is important to see how they react to a treatment in the long term to see whether treatment alters an adverse history.
For example, Weinstein said when he began his career in the 1970s, a diagnosis of adolescent idiopathic scoliosis (AIS) was basically a “death/disability sentence” and still is considered to be just that in many developing countries. When Weinstein finished his residency in the early 1970s, it was thought that children diagnosed with AIS would not lead normal lives and would be severely disabled by the condition.
“But, we showed in our natural history study that these people are just like normal people. Yes, they have more back pain than the average person, they have cosmetic concerns because they do have a deformity, but otherwise their marriage rates, their ability to have children and function in society is exactly the same as the general population,” Weinstein said.
Hip dysplasia research
As for future research, Weinstein said he is interested in researching the need for surgery in patients with hip dysplasia. After looking at data and other available information about the surgery, he said he believes the surgical options for hip dysplasia may be overused.
“There is a lot of surgery being done around the world because of hip dysplasia, because of its seemingly poor prognosis leading to arthritis as an adult. Some of the studies we have done show there is a lot of information that is yet to be determined as to which patient with dysplasia, with what type of dysplasia, will eventually get osteoarthritis and require hip replacement,” Weinstein said. “My own personal feeling is there is still too much surgery being done in the hip dysplasia realm without clear evidence to support these decisions. That is an area I hope to focus on.”
Weinstein SL. The evidence base for pediatric orthopaedics. Presented at: 15th EFORT Congress – a combined programme in partnership with the BOA; 4-6 June, 2014; London.
Disclosure: Weinstein has no relevant financial disclosures.