My recent PRP post sparked some critical comments. Good. That is exactly what scientific discussion should do. But there is one rather inconvenient aspect of the PRP literature that deserves more attention. When searching registered trials of platelet-rich plasma for osteoarthritis that were started before 2020, the overwhelming majority appear to have no publicly available […]
In an earlier post, I discussed a familiar response to negative PRP trials: the studies did not use “real” PRP. The platelet concentration was supposedly too low. The theory is appealing. Platelets release growth factors, so more platelets should mean more healing. Of course, the concentrations of cartilage-degrading molecules may also increase—but let us conveniently […]
“Optimal patient selection” is a very common argument to support the continued use of low-value surgeries such as arthscopic partial meniscectomy or re-insertion of degenerative cuff tears in elderly patients. While on average these surgeries offer no benefit to our patients, the proponents say that it is just about patient selection: you need to choose […]
This study was just published in the Arthroscopy: Little agreement between preoperative Kellgren and Lawrence classification and intraoperative Outerbridge score in patients undergoing arthroscopic partial meniscectomy And, well, the title says it all. Their study included over 400 middle-aged (average 49 years) obese patients (average BMI 30.2). Authors wrote: Understanding the degree of cartilage degeneration […]
Platelet-rich plasma or PRP is probably the most popular orthobiologic treatment nowadays. Advocates of PRP claim that it can heal and promote healing of various orthopedic conditions. None of these claims are, however, backed by good clinical evidence. Some studies show that PRP is almost a miracle drug, but these studies often have major methodological […]
I understand that the results of sham-controlled trials can be difficult to accept, especially when they challenge prior beliefs about a procedure’s efficacy. However, these trials are essential for answering the fundamental question: Does it really work? Even if you disagree with their conclusions, I urge you not to rely on the Fragility Index in […]
Orthobullets is an excellent educational platform. However, their case examples consistently seem to favor surgical treatment. This may, of course, stem from the generally surgery-oriented culture in the US. When compensation is tied to the number of operations performed, treatment preferences naturally reflect this. A recent Orthobullets case in X featured a 78-year-old female patient […]
Yes, we orthopedic surgeons are shamans or spiritual healers. And I don’t mean the magic of surgery. There is nothing magical about the majority of our operations. We are shamans because we trick ourselves and our patients with the same principles as shamans and spiritual leaders of the past. Firstly, Stuart Green wrote an excellent […]
If you decide to quote a famous writer in your article, make sure the context is preferably fundamental. Sherman and Albersheim quote Mark Twain in their opinion piece. Age is an issue of mind over matter. If you don’t mind, it doesn’t matter. Their punchline is a criticism towards a dogma, saying, “‘older’ patients with […]
Sometimes, I wonder if orthopaedics is a branch of modern medicine at all. While large, multicenter RCTs are common practice in other fields, in orthopaedics, we seem to rely on mechanical reasoning, biological plausibility, and uncontrolled before-after studies. This duality has become very visible with regard to orthopaedic sham-controlled trials. A recent research in the […]