Abstract

MARAIS, Leonard C. The changing landscape of evidence-based orthopaedics. SA orthop. j. [online]. 2017, vol.16, n.1, pp.16-18. ISSN 2309-8309.

It is difficult to find fault with the reasoning behind the move towards an evidence-based approach in the teaching and practice of orthopaedics. With numerous options available, treatment strategy selection has to be based on more than just intuition and prior experience. Furthermore, there are several strong arguments for the need to practice Evidence-Based Orthopaedics (EBO). We have seen novel implant technologies enter the market, only to exit relatively shortly afterwards. Recall metal-on-metal articulations being hailed as the solution to all our problems? Less than five years later we saw reports of 49% failure rates at six-year follow-up.¹ In addition, research continues to disprove longstanding orthopaedic axioms. We can now say, with relative confidence, that debriding an open fracture within six hours is not as important as previously believed.² This principle is also illustrated by a recent randomised study that found no advantage in the damage control concept in the treatment of femur shaft fractures in polytrauma patients.³ Interestingly, patients treated with external fixation in this series had an increased time in ICU on ventilation compared to patients treated by reamed nailing of the femur. And thus, the evidence-based tenet remains largely intact.

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