The Journal of Bone and Joint Surgery (American). 2009;91:10-14.
doi:10.2106/JBJS.H.01597
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Principles of Designing a Cohort Study in Orthopaedics

Dianne M. Bryant, MSc, PhD1, Kevin Willits, MD, FRCSC2 and Beate P. Hanson, MD, MPH3

1 Faculty of Health Sciences, The University of Western Ontario, Elborn College, Room 1438, 1201 Western Road, London, ON N6G 1H1, Canada. E-mail address: dianne.bryant{at}uwo.ca
2 Faculty of Medicine and Dentistry, Department of Surgery, The University of Western Ontario, 3M Centre, London, ON N6A 3K7, Canada
3 AO Foundation, Clinical Investigation and Documentation, Stettbachstrasse 6, 8600 Dübendorf, Switzerland

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

A well-designed and executed prospective cohort study can provide high-quality evidence in the evaluation of the effectiveness of surgical interventions. In designing a cohort study to evaluate orthopaedic interventions, it is important to recognize the limitations of the design as well as the methodological features that can be incorporated to strengthen the validity of the conclusions. In this article, we discuss the importance of the appropriate selection of participants for a control group, the management of confounders, the selection of outcomes with established measurement properties (reliability, validity, and sensitivity to change), the blinded assessment of outcomes, and the impact of nonparticipants and patients lost to follow-up.


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