I am a new physician's assistant (PA) with my first job in an orthopedic surgeon's busy practice. One of the tasks I've been given is to start collecting data on our patients with a diagnosis of femoroacetabular impingement. The goal is to find out who gets the best results, why, and then reproduce them in our other patients. I relied on information from your website all through school, so I know you can help me get started. What kind of information should I be collecting (especially if we decide to publish our results)?
This is a good question and very timely as well. Current clinical evidence for the treatment of femoroacetabular impingement (FAI) was recently published by two surgeons from Children's Hospital in Boston. The authors set out to report on current outcomes of surgical correctoin for FAI but came up empty-handed.
They discovered that most studies were from one clinic or hospital (referred to as single institution studies), which is what your study would likely be as well. Single- institution studies usually have a smaller number of cases and only one or two surgeons performing the procedures.
Single-institution studies are quite acceptable if the data collected is the same from institution to institution so that results could be combined and analyzed together (called a meta-analysis). But as these authors discovered, there was a lack of consistency in what information was collected and/or reported on.
They suggested that in order to generate useful information, it is necessary for everyone to collect and report on the same types of data. This is called standardization of data collection. For example, patients can vary tremendously in the type and severity of hip impingement. Patients can be professional athletes or stay-at-home parents so the goals and hoped for results may be different from one patient to another and one group to another.
The way surgeons measure disease severity isn't always the same. The type of surgery performed and the way surgery is performed (open versus arthroscopic) can vary. Even the way the surgery is described differs in published studies. Finally, documentation and reporting of complications are not similar enough from study-to-study to combine the results toward any useful conclusions or recommendations.
What can be done to correct this problem? A universal, consistent, and standard way to collect, process, and analyze data is needed in order to shape treatment and provide successful outcomes. The studies must use reliable tools to measure pain and level of activity as appropriate outcome measures for patients with femoroacetabular impingement (FAI).
With long-term data reporting, it will be possible to see the natural history (what happens over time) with FAI, determine who is getting the best results and why, and thus guide treatment decisions. This type of approach could make it possible for surgeons to predict which patients will do best with conservative (nonoperative) care or surgery. If surgery is deemed best, then the same process can aid in determining what approach is best: an open procedure or an arthroscopic approach?
Based on currently published studies of femoroacetabular impingement (FAI), there is a clear need for long-term data collection that is standardized across all studies. Only then will the goal be met to provide best practice and thus best outcomes for the treatment of all patients with FAI.
If you follow these principles, your study can certainly provide your surgeon with the information you are looking for within your own institution. You want to publish the outcomes in a way that makes the results useful to all. That requires careful planning to see how others are reporting results. Make every effort to conform to the high standards already set by other publications.
Ernest L. Sink, MD, and Young-Jo Kim, MD, PhD. Femoroacetabular Impingement: Current Clinical Evidence. In Journal of Pediatric Orthopaedics. September. Vol. 32. No. 2. Supplement. Pp. S166-S171.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.