Embracing the biopsychosocial and psychosocial characteristics of our patients

I write extensively about shared-decision making and patient´preferences as part of our decision making orthopaedics. Hence I considered this Invited Paper by Quaile, Mavrogenis and Scarlat in the International Orthopaedics as truly excellent piece: Managing patients’ expectations in orthopaedics. Authors write among other things: There is a problem with patient-reported outcome measurements, PROMs, as depressive symptoms and […]

No difference and type II error – a guideline?

Domb and Sebatian discuss about type II error in a “Level V guideline“. Among other things they conclude: Type II errors may be present in greater than 20% of studies that fail to find statistically significant differences. Incorrectly concluding that there is no difference in such studies poses a danger to the advancement of clinical practice, and indeed […]

Orthopaedic prediction models are getting there!

Purely predictive studies are becoming more common also in the orthopaedics. Unfortunately they have quite often very poor methodology and do not give much insight to actual prediction problems. Hence it was great to read the study by Schaefer et al. in Clinical Orthopaedics and Related Research. Their study was titled “What Factors Predict Adverse […]

Core elements in shared decision making process

Shared decision making is becoming a fundamental part of clinical practice also in orthopaedics. This should not be a problem in our field because many different questionnaires are used in SDM and our field have decades of experience in patient rated outcome measures (PROM). Valintine et al. investigated how a certain SDM questionnaire “Shared Decision […]

Implications of binomial distribution in the daily orthopaedic practice

Deep infection is a devastating complication in the orthopaedic surgery. It usually requires a revision surgery and a risk for further complications increases greatly. Functional outcome is usually much worse after deep infection compared to uneventful primary surgery especially if removal of implants is required to eridicate the infection. Deep infection are often systematically recorded […]

Arthroscopy 15 weeks before TKR surgery?

This post could be also titled “Why we dichotomize: Part XXIXCM”, but I´ll focus on the subject matter. Gu et al. investigated how prior knee arthroscopy affects the subsequent total knee replacement surgery. They concluded: This study suggests that an interval of at least 36 weeks should be maintained between the 2 procedures to minimize […]

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 […]

Continues discourse about “level V evidence”

In my recent post I discussed about “Level V Guideline” for subacromial decompression. I naturally participated to the discussion Drs Poolman and van den Bekerom had started. We wrote in our letter: ‘Optimal patient selection’ can be considered a myth until evidence of effect modifiers arises. We argue that if there were subpopulations that benefit […]

Nth conclusion about hip resurfacings

It can´t be argued that the theoretical premises of hip resurfacing arthroplasty would not have been truly great. What could sound any better than “restoring native anatomy and hip biomechanics”? As we know, everything went a different road. Clough & Clough outlined quite accurate statement about hip resurfacings: Whilst MoM HRA can, in very limited […]