Myths and Legends in Orthopaedic Practice: Are We All Guilty?

Abstract

Over years of practice, many beliefs and practices become entrenched as tried and tested, and we subconsciously believe they are based on scientific evidence. We identified nine such beliefs by interviewing orthopaedic surgeons in which studies (or lack thereof) apparently do not support such practices. These are: changing the scalpel blade after the skin incision to limit contamination; bending the patient's knee when applying a thigh tourniquet; bed rest for treatment of deep vein thrombosis; antibiotics in irrigation solution; routine use of hip precautions; routine use of antibiotics for the duration of wound drains; routine removal of hardware in children; correlation between operative time and infection; and not changing dressings on the floor before scrubbing. A survey of 186 practicing orthopaedic surgeons in academic and community settings was performed to assess their routine practice patterns. We present the results of the survey along with an in-depth literature review of these topics. Most surgeon practices are based on a combination of knowledge gained during training, reading the literature, and personal experience. The results of this survey hopefully will raise the awareness of the selected literature for common practices.

Editorial: Getting Evidence Into Practice - or Not: The Case of Viscosupplementation

“…We know that evidence diffuses into practice both slowly and inconsistently [11,25]; could the observations about increased viscosupplementation usage therefore simply represent the usual delay between discovery and implementation of evidence into clinical care? After all, the guidelines recommending against viscosupplementation are not the only ones that have yet to make the leap from paper to practice [16], and as professionals, surgeons have a reasonable aversion to ''cookbook'' medicine [24].…”

Musculoskeletal System

“…Scientific evidence is lacking to support the benefit of incorporating hip dislocation precautions into the immediate postoperative management of all patients who have undergone a THA. 44,45 Despite these findings, the therapist should be aware of common hip dislocation precautions following THA (Table 5-2).…”

Use of Lavage Fluids in Arthroplasty to Prevent Postoperative Infections

“…The use of lavage fl uids with antibiotic additives is common in the United States [ 5 ] . The biggest issue regarding the use of antibiotics is the development of bacterial resistance.…”