Resisting authority – how success measures in orthopaedics cause confusion

Description

An orthopaedic medical device's success is measured using clinical testing, patient-reported outcome measures (PROMs), and quality-adjusted life years (QALYs). However, the most significant influence has been the cumulative revision rates (CPR) reported annually by national arthroplasty registries. In 1995, the Swedish Knee Arthroplasty Register (SKAR), the most respected and influential registry for knee replacement, published a damming paper on the partial knee device Oxford Knee™ (OK) revision rate, stating that the device should only be used within a clinical trial setting. Archival evidence at Thackray Museum of Medicine showed communication between SKAR and the OK team in 1993 in which OK raised concerns about the quantities used to measure the revision rate's validity – the comparison baseline data did not add up. In addition, the review contrasted with surgeons' and patients' experience with the device, leading the OK team to collect data and analyse whether the revision rates can be considered the measure of success in all cases of prosthetic surgery. As more national arthroplasty registries emerged in the early 20th century, their influence in national health service device selection grew. However, increasing evidence showed that the revision rate did not correlate with PROMs and QALYs results, especially for partial knee devices. SKAR and other arthroplasty registries finally addressed the contradiction in results in 2018, stating that the registry revision rate represents an average patient in an average hospital. The question remains – does a revision rate still count as failure?

Period	18 Jul 2024
Event title	Society for Social History of Medicine Biennial Conference : Resistance
Event type	Conference
Location	Glasgow , United KingdomShow on map
Degree of Recognition	International