TKO for knee replacement paper, but notice raises more questions than it answers

The journal Orthopedics is retracting a paper by Chinese researchers who appear to have been a little to hasty to submit their manuscript.

Titled “Comparison of the mini-midvastus with the mini-medial parapatellar approach in primary TKA,” the October 2010 paper purported to describe a prospective, randomized study comparing two approaches to total knee arthroplasty, or knee replacement surgery. The authors, from First Affiliated Hospital of Suzhou University, stated that “all knees were implanted with the same posterior-stabilized prosthesis by the same surgeon,” a Dr. Tang.

Having claimed to have separated the effects of the surgery from those of the prosthetic — in this case, the Genesis II device from Smith & Nephew — the authors said that the study was able to demonstrate that “the early clinical results are similar between the mini-midvastus and mini-medial parapatellar approach. The mini-medial parapatellar approach is easier to initially apply and provides better visualization for TKA.”

Except that it didn’t.  Although the researchers claimed to have isolated the effects of the surgery by keeping the prosthetic the same for all 134 patients, some patients received a different device—blowing up the results.

Here’s the retraction notice:

Although the majority of clinical data were accurate for the patients undergoing the 2 minimally invasive procedures in our study, not all patients received the Genesis II prosthesis, as reported in the article; some received the LPS-Flex [Zimmer] prosthesis. Total knee arthroplasties through different minimally invasive approaches had been prospectively studied by a research team in our department, which included Junying Sun, MD. Total knee arthroplasties using the Genesis II knee prosthesis in this series were mainly performed by Dr Sun. However, all patients were prospectively followed by the co-authors. We submitted our article without communication with Dr Sun, which resulted in the errors reported in the article. Considering these inaccurate data, we withdraw our article from the literature.

As Vinnie Barbarino would say, “We’re SOOOOO confused!”

The authors first claimed that the data they used all came from the same surgeon. But that’s untrue. According to the retraction notice, they now admit to having taken patients treated by a different physician — one not listed among the authors. We’d call that more than an oversight, especially when they didn’t consult their colleague or give him credit. And the bit about “all patients” being “prospectively followed by the co-authors” smacks of disingenuity.

Finally, the authors maintain that the errors in their article resulted from their failure to communicate with Sun. That might be true, in the limited sense that they probably would have included the correct patients in their analysis. But would they then have altered the manuscript to reflect the fact that not every patient in the study was treated by Tang — a non-trival point when trying to assess differences between surgical procedures.

Although any retraction is better than none, this one barely qualifies. It smacks more of an attempt to clear the books of an uncomfortable incident than an attempt to inform readers of what really happened. We’ve seen a similar acceptance of authors’ claims before, such as in the ongoing saga of Silvia Bulfone-Paus, which we have been watching for months.

In that case, a few journal editors have allowed Bulfone-Paus’s team to say in the pages of their journals that data were reproduced, without the editors having seen said data. Editors who abdicate their responsibilities that way — and we don’t make that allegation lightly — lead us to question everything else we read in their journals.

Our position has always been that editors ought to deliver openness on these matters, and that means not letting authors off the hook easily.

We have reached out to the editor of Orthopedics, Robert D’Ambrosia, and hope to update this post with his version of events.

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