text_1: Surgeons Move From Knees to Hips
text_2: This news story introduces readers to arthroscopy as a treatment for hip pain. It explains what the procedure does and the theoretical basis for its potential benefit. But the story fails to mention costs or potential harms, and cites expert testimony in lieu of evidence. In brief:  Costs and Harms: The story mentions neither. Although harms appear to be uncommon, readers should have some sense of their relative frequency and severity. Evidence: the story says that hip arthroscopy can “fix” acetabular labral tears and femoroacetabular impingement. And yet it fails to describe the quality of the evidence to support this claim. There are virtually no high-quality clinical studies to support the treatment. The story also mentions that diagnostic imaging can be unreliable, and suggests that some doctors can pinpoint the diagnosis better than others. But recent literature reviews show that standard diagnostic techniques in use today (imaging and clinical examination) can not accurately or consistently identify the source of pain in people with hip complaints. Readers should understand that when diagnostic techniques are imprecise, people may receive treatments they don’t need or not receive treatments they do. Quantification of Benefits: The story provides no quantitative estimate of benefit in the short or mid term. A surgeon contends that in the long term, “hip arthroscopy may be a way of delaying or even possibly preventing hip arthritis.” News stories should carefully evaluate such claims. In the April 2009 issue of Clinical Orthopaedics and Related Research, editor Richard Brand,MD, concludes a commentary by saying, “While current [hip arthroscopy] procedures clearly relieve pain and restore function and to a lesser degree restore motion in large portions of patients, we do not know whether these procedures will delay the development of osteoarthritis in middle age and beyond.” (Clin Orthop Rel Res 2009;467:605-7)    Sources: The story quotes two surgeons who perform a substantial number of hip arthroscopies. Testimony from a trusted independent source who is not an advocate would add balance.