From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY (Tarwala), the Division of Adult Hip and Knee Reconstruction, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Scranton, PA (Mercuri), the Harvard Medical School, Brigham and Women's Hospital, Boston, MA (Iorio), and Lenox Hill Hospital, New York, NY (Karkare).
J Am Acad Orthop Surg. 2023 Oct 1;31(19):1001-1008. doi: 10.5435/JAAOS-D-22-00941. Epub 2023 Aug 8.
Hip and knee arthroplasty surgeries have excellent outcomes and notably improve quality of life. However, ethical issues permeate the practice of adult reconstruction, and as economics and technology evolve, these issues have become increasingly important. This article will review the currently published literature on ethical issues including industry influences, implants and instrumentations, surgical innovation, new technology adoptions, and healthcare policy-relevant issues, including patient cost sharing and bundled care programs. In addition, the direct marketing of implants from the manufacturer to the general public may falsely raise patient expectations concerning the long-term clinical outcome and performance of newer devices in the absence of long-term studies. This article will also focus on relevant contemporary ethical issues that do not necessarily have preexisting published literature or guidelines but, nonetheless, are crucial for adult reconstruction surgeons to address. These issues include access to care and challenges with orthopaedic resident and fellow education. Surgeons must understand the ethical issues that can arise in their clinical practice and how those issues affect patients. Clinicians are tasked with making the best-reasoned judgment possible to optimize their patients' outcomes. Still, the ability to standardize treatment while optimizing individual outcomes for unique patients remains a challenge.
髋关节和膝关节置换手术的效果非常好，显著提高了生活质量。然而，成人重建实践中存在伦理问题，随着经济和技术的发展，这些问题变得越来越重要。本文将回顾目前关于伦理问题的文献，包括行业影响、植入物和器械、手术创新、新技术采用以及与医疗保健政策相关的问题，如患者分担成本和捆绑式护理计划。此外，制造商直接向公众销售植入物可能会在缺乏长期研究的情况下错误地提高患者对新型设备的长期临床结果和性能的期望。本文还将重点关注一些当代伦理问题，这些问题不一定有预先存在的已发表文献或指南，但对于成人重建外科医生来说是至关重要的。这些问题包括获得医疗服务的机会，以及骨科住院医师和研究员教育方面的挑战。外科医生必须了解他们的临床实践中可能出现的伦理问题，以及这些问题如何影响患者。临床医生的任务是做出尽可能合理的判断，以优化患者的结果。然而，在为独特的患者优化个人结果的同时，实现治疗标准化仍然是一个挑战。
