James G. Wright, editor. Philadelphia: Saunders-Elsevier; 2009. 702 pages. $99.00. ISBN: 978-1-4160-4444-4.
Dr. Wright and colleagues attempt to deliver a compilation of the best information available in the literature for important orthopaedic clinical issues. The approach of Wright and his section editors is to collect all Level-I, II, and III evidence regarding questions of high clinical relevance. The book contains 100 chapters divided into sections on spine, upper extremity, pediatrics, trauma, foot and ankle, arthroplasty, and sports medicine. The Introduction is Dr. Wright's own tutorial, on evidence-based orthopaedics. This Introduction is extremely instructive and will be useful to all orthopaedic surgeons to gain a greater degree of understanding on quality clinical research and levels of evidence.
One hundred and fifty-six authors are involved with 100 chapters. The individual experience ranges from medical students to world-renowned experts in their orthopaedic subspecialty. These 100 chapters address clinically relevant, extremely important questions such as: "What is the role of vertebroplasty and kyphoplasty?" "How strong is the effect of smoking on bone healing?" and "What are the best diagnostic tests for complex regional pain syndrome?" The editors offer no explanation as to how these questions were selected, but there is no argument regarding the importance of the topics selected.
The sections are variably organized. In many of the chapters, there is a lot of text. Some authors include basic-science evidence, but most do not. The tables within the chapters are the most useful for the practicing surgeon. These are organized by author, study design, and level of evidence. The levels of evidence (I through V) as introduced by The Journal of Bone and Joint Surgery (American Volume) are the reference. These levels have been nearly universally accepted in the orthopaedic community. Each chapter has a table titled "Summary of Recommendations," graded as A, B, or C. A grade of A indicates good evidence based on Level-I studies, with consistent findings for or against recommending an intervention. B is fair evidence with Level-II or III studies, with consistent findings for or against recommending an intervention, and C is poor evidence, or Level-IV or V studies only, not allowing a recommendation. The text includes associated online access to the contents, which will be most useful for trainees.
Because of the rapid advancement of clinical research in orthopaedic surgery, the text will need to be updated regularly. Subsequently, editions will benefit by a standardized methodology for the selection of clinical questions. The incidence and prevalence of conditions should play a role in these decisions. Additionally, there should be some standardization of the search methodology. Finally, there should be more standardization of chapter format.
The approach of compiling the best evidence available for important orthopaedic conditions is unique and valuable for informing treatment discussions with patients. This orthopaedic text belongs on the shelves of all orthopaedic libraries and all hospital libraries. Orthopaedic training programs should make sure that residents and fellows have access to this very important clinical information.