Early this year, we published a paper that I am incredibly proud of. For a long time, I have thought that arthroscopic partial meniscectomy in the treatment of degenerative meniscus tears “does not make sense.” I mean that there is no credible biological mechanism for removing the torn meniscus to make the knee any better […]
Checklist for robust methodology and statistical analyses?
Recent editorial in the CORR was about EQUATOR guidelines and the editors write: Since reporting guidelines rely on consensual scientific principles and evidence-based research, consulting them before beginning a project will tend to cause clinician scientists to consider why an element of a checklist is included; doing so inevitably results in discussion and consideration of […]
Uncertainty – the uncomfortable companion in the decision making which you can´t rid of
Uncertainty related to a decision making is very interesting concept. It is poorly tolerated and it´s nature and extent is also not well understood. Medical decision making is never deterministic and hence uncertainty is present everywhere in medicine. Concept of probability is closely related to the uncertainty. Very crucial part in the patient-doctor communication is […]
Machine learning algorithm for correlation analysis – Yes!
I have a PubMed alert for studies involving search with “machine learning”. This study was included in the search list recently: “One-year Follow-Up Results with Hydrogel Implant in Therapy of Hallux Rigidus: Case Series with 44 Patients“. That really stood out. But yes, they indeed used machine learning algorithm to investigate risk factors for treatment […]
Fragility Index – Why?
Fragility Index is a completely useless metric. Literature is filled with studies claiming that findings in some field in medicine are fragile. Maldano et al conclude: A systematic survey of hip arthroscopy RCTs resulted in a low FI, indicating that the findings tended to be fragile. What is the point to calculate FI for outcomes […]
Resentment around arthroscopic surgery
Ardern and co-workers proposed five reasons which would explain the declining worldwide arthroscopic meniscectomy rates (see my previous post on this topic). Among other things they wrote: If one cannot congratulate the funders for limiting arthroscopy, perhaps a broad-based, international consensus on the need for medical reversal was responsible? One might expect such a consensus […]
Methodological aspects for future in the TJR research
Cuthbert et al. published a study in CORR titled “What Is the Effect of Using a competing-risks Estimator when Predicting Survivorship After Joint Arthroplasty: A Comparison of Approaches to Survivorship Estimation in a Large Registry“. They recommend using competing risk approach when assessing long-term survival of total joint replacements. This is of course an important […]
Prediction is hard and prediction is even harder for postoperative infections
Deep infection after a major orthopaedic surgery is a devastating complication. A prediction model with excellent predictive performance for deep infections would be extremely valuable for example in joint replacement surgery. The problem is that a deep infection is (fortunely) very rare event. Overall infection rate is close to 1% in the modern total knee […]
More well developed orthopaedic prediction models
It seems that appropriate methodology in the development of prediction models is becoming more common in our field. These two recent studies caught my attention: Development of a model to predict the probability of incurring a complication during spine surgery and Prediction of 90-day mortality after total hip arthroplasty. Both studies report calibration performance and […]
Orthopaedic journals really stand out and not in a good way
Preprint policy of majority of academic journals can be found in the Wikipedia: https://en.wikipedia.org/wiki/List_of_academic_journals_by_preprint_policy. Some 130 journals can be found in the list. Large majority of journals allow preprints prior to submission. Few journals have restrictions. Four journals glow in red since journal policy does not allow preprints. Which journals would they be? These journals […]