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The Journal of Bone and Joint Surgery (American) 83:916-926 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Current Concepts Review

User’s Guide to the Orthopaedic Literature: How to Use an Article About a Surgical Therapy

Mohit Bhandari, MD, MSc, Gordon H. Guyatt, MD, MSc and Marc F. Swiontkowski, MD

Investigation performed at the Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Center, Hamilton, Ontario, Canada, and the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
This article is the first in a series designed to help the orthopaedic surgeon use the published literature in practice. We start with the topic of the controlled trial, which is widely considered to be the study design of greatest utility because of its systematic attempts to limit bias. Controlled trials are difficult to perform in surgery but are being conducted with increasing frequency.
M. Bhandari, MD, MSc
G.H. Guyatt, MD, MSc
Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Center, Room 2C12, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada. Please address requests for reprints to G.H. Guyatt. E-mail address for M. Bhandari: bhandari{at}sympatico.ca

M.F. Swiontkowski, MD
Department of Orthopaedic Surgery, University of Minnesota, Box 492, Delaware Street N.E., Minneapolis, MN 55455

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Summary

We suggest a three-step approach when using an article from the surgical literature to guide your patient care: (1) assess whether the study can provide valid results, (2) review the results, and (3) consider how the results might be applied to your patient.

Randomization, concealment, intention-to-treat analysis, similarity of patients for known prognostic factors, blinding of patients and outcome assessors, and completeness of follow-up are important guides to study validity.

The 95% confidence interval around the treatment effect is a measure of precision.

Consider whether all of the clinically important outcomes were reported and whether the likely benefits of treatment outweigh the potential harm and costs.


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