Promoting evidence based orthopaedic surgery. An English experience.

Orthopaedic surgery is a high volume and high cost specialty. The global disease burden from musculo-skeletal conditions is increasing and this spurred the World Health Organisation to declare the 2000–2010 as the Bone and Joint Decade. Simultaneously, there are concerns about provision of adequate services to meet the musculoskeletal needs of the population. Long waiting times for access to elective procedures such as joint replacements have been of concern to policy makers, professionals and the public in many parts of Europe. Questions have been raised about the quality of some of the interventions also. For example, the number and variety of implants used for total hip replacement in the UK have been questioned and the lack of evidence of superiority of newer and more expensive implants over older designs highlighted (Murray et al. 1995, National Audit OfŽ ce 2000). Standards of care of patients with hip fractures have shown striking variation in both, process and outcome (Todd et al. 1995). Since the early 1990s there has been a growing interest, worldwide, in evidence based medicine (EBM) which seeks to integrate individual clinical expertise with best available clinical evidence from systematic research (Sackett et al 1997). Many clinicians have embraced the principles of EBM and there is considerable support from policymakers and health care managers who see EBM helping to provide effective health care and to increase efŽ ciency. In this paper, we describe our experiences of promoting evidence based orthopaedic surgery (EBOS) in Teesside, England and share future planned developments. Promoting evidence based orthopaedic surgery