Can orthopedic trials change practice?

Abstract

Background and purpose The impact of large, randomized trials in orthopedic surgery on surgeons' preferences for a particular surgical approach remains unclear. We surveyed surgeons to assess whether they would change practice based upon results of a large, multicenter randomized controlled hip fracture trial.

Methods We conducted a cross-sectional survey among International Hip Fracture Research Collaborative (IHFRC) surgeons and surgeons who were members of Arbeitsgemeinschaft fuer Osteosynthesefragen - Association for the Study of Internal Fixation (AO/ASIF) to determine the likelihood that they would change practice based on findings of a proposed large, multicenter randomized controlled trial (the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemi-Arthroplasty (HEALTH) study). We asked surgeons their current preferences for the management of displaced femoral neck fractures and whether a trial that definitively revealed a substantial improvement in function and quality of life with no difference in risk of revision surgery was important and would cause them to change practice.

Results Of 883 surgeons surveyed, 210 responded from IHFRC and 586 from AO/ASIF (a response rate of 90%). Most surgeons (61%) preferred hemiarthroplasty (HA) for treating displaced femoral neck fractures. 72% of responding surgeons believed that a substantial improvement in patient function with total hip arthroplasty (THA) and no adverse effects on revision surgery would be an important finding. Moreover, of 483 surgeons who preferred hemiarthroplasty, 62% would change their practice based upon the findings of the trial.

Interpretation Large clinical trials in orthopedics are worthwhile endeavors, as they have the potential to change practice among surgeons. Surgeons seem willing to adopt alternative surgical approaches if the evidence is compelling and sound.

Acknowledgments

The survey was planned and designed by JP, SS, and MB. It was conducted by JP, SS, BPH, and MB. The statistical analysis was performed by BGD, BWK, and JP. BGD, BWK, JP, SS, and MB participated in the interpretation of the results and in preparation of the manuscript.

We thank Helena Viveiros and Eric Morrison for their assistance with administration of the survey. No funding was received for the preparation of this manuscript. Mohi Bhandari is funded, in part, by a Canada Research Chair.

The survey was based on an ongoing randomized trial funded by The Canadian Institutes of Health Research (CIHR), the National Institute of Arthritis, Musculoskeletal, and Skin Diseases (NIAMS) at the National Institutes of Health (NIH), USA, and ZonMw, the Netherlands Organization for Health Research and Development.