BBB National Programs Archive

NAD Recommends Virtua Health System Discontinue Challenged Claims for ‘Quad-Sparing’ Knee Replacement Surgery

New York, NY – Sept. 3, 2014 –The National Advertising Division has recommended that Virtua Health System discontinue certain advertising claims for the hospital chain’s minimally invasive, “quad-sparing” knee-replacement surgery.

NAD is an investigative unit of the advertising industry’s system of self-regulation. It is administered by the Council of Better Business Bureaus.

The claims, challenged by The Rothman Institute, a competing provider of orthopedic surgery services, appeared in print, radio and video advertisements and promotional literature, and were posted at Virtua’s website.

Claims at issue included:

  •  “It’s what we don’t cut that counts.” 
  •  “Because we don’t cut the quadriceps tendon, patients have a significantly reduced recovery time.”

Rothman and Virtua both have a strong presence in the Northeastern United States and the Mid-Atlantic region and the advertising claims at issue were broadly distributed.

As NAD noted in its decision, while surgeons at both Virtua and Rothman use minimally invasive techniques when performing knee replacement surgery, the parties dispute the purported benefits of one particular type of minimally invasive surgery – the quad-sparing technique – as compared to other surgical approaches to knee replacement.

The advertiser contended that quad-sparing surgery, which “spares” from cutting the quadriceps tendon above the kneecap, allows patients to heal more quickly. The challenger maintained there is no measurable difference in outcomes between patients who undergo the quad-sparing procedure and those who undergo traditional knee replacement surgery or other minimally-invasive surgeries.

In this case, the advertiser relied on clinical research studies, abstracts and meta-analyses to support its “faster recovery” claims, as well as the results of a federal patient satisfaction survey (Hospital Consumer Assessment of Healthcare Providers and Systems or HCAHPS) and its own survey of patients who had surgery at the Virtua Joint Replacement Institute (VJRI), compared to those who had surgery at other Virtua facilities.

Following its review of the evidence in the record, however, NAD determined that the meta-analyses and their conclusions with respect to the superiority of minimally-invasive surgery in general, weren’t adequately tailored to the specific claims at issue, which relate only to quad-sparing surgery.

NAD noted in its decision that while it appreciated that patients at the VJRI have consistently high satisfaction scores, such evidence was not reliable support for the advertiser’s claims that the minimally invasive, quad-sparing knee-replacement technique provided patients with faster recovery than those who underwent other types of knee replacement surgery.  Although patient satisfaction may be related to actual performance, NAD said, for the purposes of advertising claim substantiation these are, in fact, two distinct inquiries.

Finally, NAD noted VJRI patients who had undergone the minimally-invasive, quad-sparing procedure had a shorter length of stay and fewer needed extended inpatient rehabilitation as compared to patients who had knee replacement procedures at other Virtua facilities, but not in the VJRI.

NAD noted that Virtua’s data tended to indicate that VJRI patients experienced a shorter stay. However, NAD said, “there are many reasons why the length of stay could be shorter at the VJRI, not all of which are related to the type of surgical approach used.”

NAD determined that the advertiser’s evidence was insufficient to support its faster recovery claims and recommended that the challenged claims – including express claims and those made through patient testimonials – be discontinued.

NAD noted that nothing in its decision precludes the advertiser from accurately communicating to consumers the benefits of the minimally invasive, quad-sparing knee-replacement technique, as long as the advertiser avoids conveying the unsupported message that the technique provides faster recovery than other types of knee replacement procedures.

Virtua, in its advertiser’s statement, said it disagreed with NAD’s decision, but would “voluntarily discontinue express claims of faster recovery in its advertising, and will allow patients to truthfully recount their personal experiences in compliance with the decision.”