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 […]

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 […]

The fallacy of “meniscal of symptoms”: part 2

I don´t have anything else to add to my post from yesterday, besides what MacFarlane conclude: “Meniscal symptoms” were not associated with improved pain relief. Although symptoms of clicking and intermittent locking had a greater reduction in the APM group, the presence of “meniscal symptoms” in isolation should not inform clinical decisions surrounding APM vs. […]

The fallacy of “meniscal symptoms”

A long story short. Farina et al. conclude: Contrary to current dogma, this study demonstrates that traditionally defined “meniscal” and “mechanical” knee symptoms are strongly associated with the burden and severity of underlying cartilage damage rather than with specific meniscal pathology. It is only relevant to ask how could an arthroscopic partial meniscectomy be an […]

When we stop “treating” degeneration?

This is a second post about an excellent Invited Paper in the International Orthopaedics. Authors begin their paper as follows: The specialism of orthopaedic surgery covers many subdisciplines. Most of these deal with degenerative changes occurring as a result of the normal aging process. Some will follow trauma or are as a result of congenital […]

How to investigate “novel techniques”?

I liked the study by Lapner et al. very much. Their study was titled “Preoperative bone marrow stimulation does not improve functional outcomes in arthroscopic cuff repair: a prospective randomized controlled trial”. They proposed a new concept to improve healing of rotator cuff repair. Authors hypothesized that preoperative ultrasound-guided bone channeling in the footprint 5-7 […]

Mesenchymal stem cells outperforming total knee replacement

Tan et al. published a meta-analysis about mesencymal stem cells in the tretment of osteoarhritis. They reported pooled estimates as follows: The standardized mean differences (SMDs) for the visual analog scale (VAS) for pain at rest and upon exertion were –1.48 (95% CI, –1.85 to –1.11) and –2.25 (95% CI, –2.64 to –1.85), respectively. This […]