Posts by Aleksi R:

Cup coverage and dislocation risk in THA

This is one of our recent work from Coxa Hospital for Joint Replacement. This relates to post-marketing surveillance which is always very important topic. In short, main primary THR system changed and anecdotal evidence started to accumulate that maybe dislocations had become more common with the new cup system. We decided to take a deeper […]

Views of orthopaedics – part 2

I continue discussing an excellent editorial published in the BJJ. Alex Trompeter writes: We are now seeing the pendulum swing in terms of treatments we select, as our understanding of the science of fracture fixation improves. Moreimportant, however, is the recognition that the patient’s own experience is the most vital outcome when measuring the success […]

Views on orthopaedics motivated by recent editorial – Part 1

A recent editorial in the Bone & Joint Journal was about weight-bearing in orthopaedic traumatology. Written by Alex Trompeter, the title was intriguing: A call to arms: it’s time to bear weight! This editorial was best I have read in a while. Besides weight-bearing, Trompeter addressed many other general topics. In following posts I will […]

Why do we need randomized trials?

Discussion about randomized controlled trials (RCT) has been extensive in social media during this spring due to corona virus epidemic. This discussion was especially heated when “not so good” clinical trial was published stating that hydroxychloroquine is efficient in the treatment of corona virus disease (CoViD-19). I drew this picture and posted it on Twitter. […]

Exploratory or confirming study?

Methodology is hard. And making valid inferences is very hard. With regard to these topics, orthopaedic research is not very different to other field in medicine. It means that misconceptions, misunderstandings and flawed approaches are prevalent also in our field. American Journal of Sports Medicine published recently two papers which both made a quite common, […]

Treatment outcomes and shared decision making

Key points Clinical equipoise will become more common in orthopaedics When treatment outcomes are subjective and have large heterogeneity, shared decision making should be used Clinical equipoise means a situation when there is no objective superiority between two choices. The lack of superiority may be due to complete lack of data or evidence about certain […]

Population health and orthopaedic surgeries

Both knee arthroscopy for partial meniscectomy and shoulder arthroscopy for acromioplasty were very common procedures few years back in orthopaedic surgery. During the first two decades of this millennium extensive amount of research has been published showing that the effect of these procedures to treat knee and shoulder pain and function is quite weak. Despite […]

Propensity scores, orthopaedics and shared decision making

This is something I posted on Twitter last October. Extended discussion can be found below the tweets Propensity score matching is often used when two cohorts of patient are compared. Aim is to have somewhat comparable groups so effect of treatment or intervention could be estimated reliably. In short, two groups of patient tread by […]

Uncertainty in medical decision making

“The failure to train doctors about clinical uncertainty has been called “the greatest deficiency of medical education throughout the twentieth century.” Djulbegovic (2004), https://www.bmj.com/content/329/7480/1419 Life is full of uncertainties. In decision making uncertainty means that it is impossible to define future outcomes. Amount of medical information continues to grow exponentially, but uncertainty is still inevitable […]

No evidence of no evidence

In the null hypothesis significance testing framework, failure to reject the null is never evidence in support of null. However, it is extremely common that failure to reject the null, ie. getting a p-value larger 0.05 is interpreted as “no difference” or “no evidence”. As many experts have said, “absence of evidence is not evidence […]

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