Orthopaedic surgeons want what is best for their patients. Determining best
practice, however, is not always straightforward. Clinicians use many sources
of information to determine treatment options for their patients. Surgeons
rely in large part on their training. As surgeons progress through their
careers, practice learned through training is influenced by their own
experience, the advice of colleagues, and their personal learning, including
continuing medical education and the use of texts or the surgical literature.
One of the more powerful forces in shaping best practice is, and should be,
the surgical literature. The literature, however, is often contradictory.
Contradictory literature leads to conflicting treatment recommendations for
many conditions, and, in some situations, to a complacency among surgeons that
anything goes (as surgeons can find some support for just about anything in
the literature). Varying treatment recommendations in the literature and
subsequent variation in practice may be acceptable if different treatments
address different clinical situations, if different treatments have similar
outcomes, or if different treatments address the variation in patient
preferences. Barring these circumstances, if different treatments have
meaningful differences in outcome, then practice variation may adversely
affect patient outcomes.