Ideally, textbooks should give an up-to-date complete summary of the
literature, providing clinicians with the information they need to make
treatment decisions with their patients. Textbooks, however, often provide an
incomplete review of the literature and are heavily influenced by the opinions
of the author. The Evidence for Orthopaedic Surgery offers a welcome
new approach to an orthopaedic textbook. The book is based on systematic
reviews of the literature, with a focus on the highest quality evidence.
Levels of evidence are assigned to many of the studies discussed. Each chapter
has a useful table of recommendations, allowing the reader to quickly access
the conclusions of the chapter. More importantly, the recommendations are
graded, thus providing some sense of the strength of evidence supporting the
recommendations. Some of the chapters on selected topics in this book are
among the best that have been written.
This text, however, has several important shortcomings. The first chapter
begins with a discussion of evidence-based orthopaedics, including a statement
regarding the "difficulties in constructing randomized controlled trials
for surgical procedures" and the belief that "most of the major
advances in orthopaedic surgery, including the development of successful joint
replacement surgery and the skeletal stabilization of trauma victims, occurred
before the concept of evidence-based medicine was born." Although both
of these statements are true, it is peculiar to start a book that purports to
promote the concept of evidence-based medicine with such caveats.
The book uses levels of evidence that are appropriate only for therapeutic
studies and does not address diagnostic and prognostic studies. Although each
chapter begins with a section, entitled Methodology, that details the search
strategies used to assemble the literature, some chapters provide no search
terms. In addition, the databases that were searched differ among chapters,
the years of search were inconsistent, and the levels of evidence used in each
chapter vary.
Finally, the audience for the book is not explicit. The editors have
provided no rationale for their choice of chapters. Some chapters have a large
scope, such as the acute management of patients with spinal cord injury. Other
chapters are quite narrow; an entire chapter has been devoted to the glenoid
component of total shoulder replacements. The numbers of chapters devoted to
body regions or topics are unbalanced and do not reflect the practice of most
orthopaedic surgeons. For example, five chapters are devoted to the shoulder
whereas only two chapters are devoted to lower-extremity fractures. Given the
unevenness of the content, this book would serve neither as a comprehensive
reference nor as a general introductory text. This book best serves as an
extremely useful collation of the current evidence and would be most useful to
a reader of a particular topic, if that topic were covered in this textbook.
In summary, I congratulate the editors and the authors for their approach to
the topic, and I extend the hope that their approach will influence the next
generation of textbooks for orthopaedic surgeons.