ABSTRACT
Orthopaedic clinical practice is largely based on empirical knowledge. We have relied on observational studies and personal experience. Our teachers learned this way, and we have modified or occasionally revolutionized their ideas. We apply these ideas to individual patients in an often arbitrary or idiosyncratic fashion. Usually, a ‘reasonable body’ of opinion can be rallied round to support our clinical judgement when things go wrong. In contrast, the rest of medicine (but less obviously surgery) is advancing down an ‘evidence-based’ route, which is empowered by the Randomized Controlled Trial (RCT), which is generally agreed to be the most powerful method of establishing the optimal management. Other generic trial designs are shown in Table 4.1.
