TO THE EDITOR:
After reading "Rate of Degeneration of Human Acetabular Cartilage after Hemiarthroplasty" (77-A: 877—882, June 1995), by Dalldorf et al., I wondered whether the biopsy of cartilage and subchondral bone from the weight-bearing dome of the acetabulum in the control patients had been approved by an institutional review board with knowledgeable orthopaedic representation. The article made no mention of such approval. Did these control patients give adequate informed consent not only for the treatment of the fracture of the hip but also for the acetabular biopsy? If so, how was such consent obtained in the acute fracture situation, in which, it would seem to me, it would be unduly difficult to have a calmly reasoned discussion of the patient's personal risks from having a portion of the acetabular dome removed compared with the societal benefits from studying the rate of acetabular wear.
Ralph B. Blasier, M.D.: Orthopaedic Department, The Detroit Medical Center, Wayne State University, Grace Hospital, 6071 West Outer Drive, Detroit, Michigan 48235
Dr. Dalldorf, Dr. Banas, Dr. Hicks, and Dr. Pellegrini reply:
Dr. Blasier appropriately questions the role of informed consent in the procurement of biopsy specimens of acetabular cartilage from control subjects. These specimens were obtained from the superolateral aspect of the dome of the acetabulum with a hollow needle that was 1.5 to 2.0 millimeters in diameter. The resulting defect was smaller than that remaining after penetration of the hip joint with a guide-pin, as used by some surgeons for placement of a compression hip-screw. Because we perceived no adverse effect from procurement of such a small biopsy specimen and we believed that the procedure did not materially affect the treatment offered to the patient, formal written informed consent was not obtained. However, Dr. Blasier's point is well taken, regarding both the appropriateness of informed consent and the difficulty in obtaining such permission in the acute fracture situation after an unanticipated injury that is to result in an operation.
Were this study to be performed in a prospective and controlled fashion, written informed consent would surely be a part of the investigational protocol.
Peter G. Dalldorf, M.D.: Guilford Orthopaedics and Sports Medicine Center, 809 Green Valley Road, Greensboro, North Carolina 27408
Michael P. Banas, David G. Hicks, M.D.: University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, New York 14642
Vincent D. Pellegrini, Jr., M.D.: Department of Orthopaedics, Pennsylvania State University College of Medicine, P.O. Box 850, Hershey, Pennsylvania 17033