Evidence Based Medicine in Orthopedic Surgery, An Issue of Orthopedic Clinics

Munish C. Gupta, Mark A. Lee, Safdar N. Khan

Description

Articles include: Definition and Principles, Evidence-Based Orthopaedics: Is it possible? Conflict of Interest and Orthopaedic Publications, SPRINT Trial, Clavicle fractures, Intracapsular femur neck fractures, SPORT trial: Spinal stenosis, Cervical spondylotic myelopathy – anterior vs posterior approaches, Total disc replacement vs Fusion, Flexible constructs for spinal fusion, DVT prophylaxis in adult reconstruction, Hip resurfacing – what is the evidence, Graft selection/type in ACL surgery, LEAP Trial, BESTT Trial, SPORT trial: Lumbar disc herniations,

SPORT trial: Degenerative spondylolisthesis.

Sujets

• Medical
• Médecine
• Orthopedics

Informations

• Publié par: Saunders
• Date de parution: 05 mai 2010
• Nombre de lectures: 0
• EAN13: 9781455700509
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Orthopedic Clinics of North America , Vol. 41, No. 2, April 2010
ISSN: 0030-5898
doi: 10.1016/S0030-5898(10)00021-0

Contributors
Orthopedic Clinics of North America
Evidence Based Medicine in Orthopedic Surgery
Safdar N. Khan, MD
Department of Orthopaedic Surgery, Lawrence J. Ellison Ambulatory Care Center, University of California, Davis, 4860 Y Street, Suite 1700, Sacramento, CA 95817, USA
Mark A. Lee, MD
Department of Orthopaedic Surgery, Lawrence J. Ellison Ambulatory Care Center, University of California, Davis, 4860 Y Street, Suite 1700, Sacramento, CA 95817, USA
Munish C. Gupta, MD
Department of Orthopaedic Surgery, Lawrence J. Ellison Ambulatory Care Center, University of California, Davis, 4860 Y Street, Suite 1700, Sacramento, CA 95817, USA
ISSN  0030-5898
Volume 41 • Number 2 • April 2010

Contents
Cover
Contributors
Contents
Forthcoming issues
Evidence–Based Medicine in Orthopedic Surgery
Principles of Evidence-Based Medicine
Evidence-Based Orthopedic Surgery: Is It Possible?
Challenges of Randomized Controlled Surgical Trials
Optimal Treatment of Femoral Neck Fractures According to Patient’s Physiologic Age: An Evidence-Based Review
Fusion Versus Disk Replacement for Degenerative Conditions of the Lumbar and Cervical Spine: Quid Est Testimonium?
Contemporary Management of Symptomatic Lumbar Spinal Stenosis
Cervical Spondylotic Myelopathy: A Review of the Evidence
Dynamic Constructs for Spinal Fusion: An Evidence-Based Review
Contemporary Management of Symptomatic Lumbar Disc Herniations
Clavicle Fractures in 2010: Sling/Swathe or Open Reduction and Internal Fixation?
Lower Extremity Assessment Project (LEAP) – The Best Available Evidence on Limb-Threatening Lower Extremity Trauma
A Critical Appraisal of the SPRINT Trial
Graft Selection for Anterior Cruciate Ligament Reconstruction: A Level I Systematic Review Comparing Failure Rates and Functional Outcomes
Hip Resurfacing Arthroplasty: A Review of the Evidence for Surgical Technique, Outcome, and Complications
DVT Prophylaxis in Total Joint Reconstruction
Index
Orthopedic Clinics of North America , Vol. 41, No. 2, April 2010
ISSN: 0030-5898
doi: 10.1016/S0030-5898(10)00023-4

Forthcoming issues
Orthopedic Clinics of North America , Vol. 41, No. 2, April 2010
ISSN: 0030-5898
doi: 10.1016/j.ocl.2010.03.003

Preface
Evidence–Based Medicine in Orthopedic Surgery

Safdar N. Khan, MD
Department of Orthopaedic Surgery, Lawrence J. Ellison Ambulatory Care Center, University of California, Davis, 4860 Y Street, Suite 1700, Sacramento, CA 95817, USA
E-mail address: [e-mail]
E-mail address: [e-mail]
E-mail address: [e-mail]

Mark A. Lee, MD ,
Department of Orthopaedic Surgery, Lawrence J. Ellison Ambulatory Care Center, University of California, Davis, 4860 Y Street, Suite 1700, Sacramento, CA 95817, USA
E-mail address: [e-mail]
E-mail address: [e-mail]
E-mail address: [e-mail]

Munish C. Gupta, MD ,
Department of Orthopaedic Surgery, Lawrence J. Ellison Ambulatory Care Center, University of California, Davis, 4860 Y Street, Suite 1700, Sacramento, CA 95817, USA
E-mail address: [e-mail]
E-mail address: [e-mail]
E-mail address: [e-mail]


Mark A. Lee, MD Guest Editor

Safdar N. Khan, MD Guest Editor

Munish C. Gupta, MD Guest Editor
The principles of evidence-based medicine have been available to us since “The Canon of Medicine” was completed in 1025 by Avicenna. The application of best available evidence to contemporary clinical decision making is not a new one—however, our appreciation of the impact these concepts have on patient care have recently become a subject of great interest.
The current issue of the Orthopedic Clinics of North America is dedicated to understanding the application of evidence-based medicine as it relates to the art and science of orthopedic surgery. Contemporary readers have unparalleled access to many publications explaining the core principles of evidence-based research in orthopedic surgery; however, we (and an exceptional cadre of contributing authors) have focused specifically on an evaluation of the quality of evidence in several controversial areas in orthopedic surgery. This list is far from conclusive; however, our hope is that readers will use these articles and their methodology as a template for evidence-based treatment recommendations.
We would like to congratulate and thank all of our authors for their generous efforts and thoughtful contributions to this compilation. Finally, we would like to acknowledge the vision, dedication, and perseverance of Deb Dellapena at Elsevier, who has made developing this volume an immense pleasure.
Orthopedic Clinics of North America , Vol. 41, No. 2, April 2010
ISSN: 0030-5898
doi: 10.1016/j.ocl.2009.12.001

Principles of Evidence-Based Medicine

Sukhmeet S. Panesar, BSc (Hons), MBBS a , Marc J. Philippon, MD b , Mohit Bhandari, MD, MSc, FRCSC c , *
a Patient Safety Division, National Patient Safety Agency, 4-8 Maple Street, W1T 5HD, London, UK
b Steadman Hawkins Research Foundation, 181 West Meadow Drive, Suite 1000, Vail, CO 81657, USA
c Faculty of Health Sciences, Division of Surgery, Department of Orthopedic Surgery, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, Ontario L8S 4L8, Canada
* Corresponding author.
E-mail address: [e-mail]

Abstract
Evidence–based medicine integrates clinical expertise, patients’ values and preferences, and the best available evidence from the medical literature. Evidence–based orthopedics is a model to assist surgeons to improve the process of asking questions, obtaining relevant information efficiently, and making informed decisions with patients. With an increasing appreciation for higher levels of evidence, orthopedic surgeons should move away from lower forms of evidence. The adoption of randomized trials and high-quality prospective studies to guide patient care requires 2 prerequisites: (1) greater appreciation for the conduct of randomized trials in orthopedics and (2) improved education and training in evidence-based methodologies in surgery.

Keywords
• Evidence-based medicine • Orthopedics • Statistics • Evidence synthesis
The origins of what is currently known as evidence-based medicine (EBM) go as far back as the seventeenth century, when it was observed that patients who received bleeding as part of their treatment of cholera had a much higher mortality rate than those who were not treated in the same manner. 1 It has only been recently that EBM has seen an exponential increase in its adoption, and indeed the development of EBM has been heralded as one of the top medical milestones over the last 160 years. 2 Although definitions vary, EBM integrates clinical expertise, patients’ values and preferences, and the best available evidence from the medical literature. 3 In other words, as suggested by Sackett and colleagues, 4 “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”
Historically, surgical decisions have largely been based on personal experience and recommendations from surgical authorities. In contrast to internal medicine, trials of surgical techniques and technologies have unique challenges and have, therefore, been slow to permeate the surgical literature. In addition, regulatory bodies have imposed less stringent controls on the validation of these technologies. As such, most surgical practice is based on lower levels of evidence. 5 The proportion of systematic reviews and randomized controlled trials (RCTs) in leading surgical journals stands at 5%. 6
Regardless of the overall number of trials in surgery, it is extremely difficult for practicing surgeons to keep abreast of critical evidence, given the large number of surgical articles published monthly. Haynes stipulates that doctors need to read approximately 20 articles a day to keep up to date in their field. 7
Surgery is an exponentially growing specialty with 234 million operations performed globally in a year. 8 Of these, 64 million are performed in the United States, and health care accounts for one-sixth of the economy. 9 Furthermore, Internet-savvy patients who want the best in diagnostics and therapies demand evidence-based practice. The onus is on surgeons to provide high-quality evidence and institute best practices.

Evidence-based orthopedics
Current estimates suggest that less than 5% of the orthopedic literature represents randomized trials, although this has been steadily increasing. 10 However, even the quality of reporting in RCTs is highly variable. Complete reporting of allocation concealment, details of blinding in follow-up, and surgical expertise in trial reports have been uncommon. 11
Although many orthopedic journals (eg, Journal of Bone and Joint Surgery , Clinical Orthopaedics and Related Research , Acta Orthopaedica , Journal of Orthopaedic Trauma , and Orthopedic Clinics of North America ) have adopted evidence-based approaches to reporting clinical research, there remain considerable opportunities to improve processes. Providing additional evidence-based resources and education for readers is a