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The Journal of Bone and Joint Surgery (American) 83:1555-1564 (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 Prognosis

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, Hamilton, Ontario, Canada, and the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
This article is the second in a series designed to help the orthopaedic surgeon use the published literature in practice. In the first article in the series, we presented guidelines for making a decision about therapy and focused on randomized controlled trials. In this article, we focus on evaluating nonrandomized studies that present information about a patient’s prognosis.

Mohit Bhandari, MD, MSc
Gordon 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. E-mail address for M. Bhandari: bhandari@sympatico.ca

Marc 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.


   Introduction
 
Prognosis studies are investigations examining the possible outcomes of a disease or operative procedure and the probability with which they can be expected to occur.

Primary guides for assessing the validity (study methodology) of a prognosis study are:

Was there a representative sample of patients?

Were the patients sufficiently homogeneous with respect to prognostic risk? If not, did the investigators provide estimates for all clinically relevant subgroups?

Secondary guides for assessing the validity (study methodology) of a prognosis study are:

Was follow-up sufficiently complete?

Were objective and unbiased outcome criteria used?


   Clinical Scenario
 
You are an orthopaedic surgeon consulting on the case of a seventy-seven-year-old woman with osteoarthritis in the right hip causing pain and functional impairment who was referred to you by a local family physician. The woman had a left total hip arthroplasty twelve years ago, with a good result. For the present problem, she received a course of conservative . . . [Full Text of this Article]


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