Orthopedic Surgery

PJI studies use inconsistent outcome definitions; propose a core outcome set.

PJI affects about 2% of arthroplasty patients but outcome definitions are highly heterogeneous across studies. Systematic review of 461 studies (mostly retrospective) found inconsistent use of clinical, microbiologic, surgical, mortality, imaging, histology, and antibiotic domains. Only 24.1% of studies reported PROMs, with 36 different instruments identified and Knee Society/Harris scores most common. Authors propose a working PJI core outcome set including PROMs and antibiotic-related measures to harmonize research. 1

Causal inference methods are used but formal frameworks are underutilized in orthopaedics.

Scoping review included 85 studies from 6,244 records and mapped causal methods used in orthopaedic observational research. Propensity score methods and inverse probability weighting were common, while target trial emulation and DAGs were rare. The authors recommend prospective, publicly available protocols that incorporate formal causal frameworks to improve validity. Adoption of these frameworks could reduce bias in non-randomized treatment-effect estimates. 2

Modified Zelen randomization was acceptable to most THA trial participants after disclosure.

Survey of 235 CAPS-THA participants (81% response; mean age 70.1 years) assessed reactions to delayed-consent randomization. After disclosure, 76% judged the design justified and 94% reported unchanged or increased trust in research. Most respondents had a pretrial preference, and 36% would have wanted more information about the alternative pathway upfront. Authors conclude modified Zelen designs can be ethically acceptable if paired with robust debriefing and post-disclosure choices. 3