RT Journal
A1 Schemitsch, Emil H.
A1 Bhandari, Mohit
A1 Boden, Scott D.
A1 Bourne, Robert B.
A1 Bozic, Kevin J.
A1 Jacobs, Joshua J.
A1 Zdero, Rad
T1 The Evidence-Based Approach in Bringing New Orthopaedic Devices to Market*
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2010
FD April 1
VO 92
IS 4
SP 1030
OP 1037
DO 10.2106/JBJS.H.01532
UL http://dx.doi.org/10.2106/JBJS.H.01532
AB 
In 2007, the British Medical Journal reported the fifteen most important medical milestones since the inception of that journal in 18401. Included were the discovery of DNA, the development of vaccinations and of antibiotics, the use of anesthetics for surgery, and evidence-based medicine. The practice of evidence-based medicine can be conceptualized as the integration of the best available research evidence, the clinical circumstances, and the values and preferences of the patients. Clinical expertise is critical to the practice of evidence-based medicine, allowing the sensible and skilled application of best evidence to patients. The use of best evidence implies a hierarchy. This hierarchy, described by Sackett et al.2 in 1996, can be visualized as a pyramid of evidence with randomized trials on top (Level I) and expert opinion on the bottom (Level V). For a therapy, Level-I evidence obtained from randomized controlled trials remains the highest standard for the most valid information.