Dispelling Myths and Legends about Total Joint Arthroplasty

    Do orthopaedic surgeons practice evidence-based medicine?

    Sometimes yes, sometimes no, according to Bryan D. Springer, MD: Data suggest, he said, that evidence-based medicine and clinical practice guidelines are followed about 50% of the time.

    Consider the use of cementless stems in primary total hip arthroplasty. The literature overwhelming shows that older patients – especially older females – are at increased risk of periprosthetic fractures with cementless compared with cemented stems. [1] Yet data from the American Joint Replacement Registry show that in the US in particular, these patients continue to receive cementless stems despite the known risk. [2]

    Dr. Springer, whose comments introduced the session on Urban Legends in Total Joint Arthroplasty at ICJR’s Winter Hip & Knee Course, said that surgeons are highly influenced by:

    • What they were taught in residence and fellowship
    • The practice patterns in their region
    • The preferences of their partners and marketing by industry
    • What they learn at meetings they attend

    As a result, many of their beliefs and practices become so entrenched over so many years that they are thought to be have originally been based on science, even when they may not have been.

    With that in mind, Dr. Springer said that the goals for the Urban Legends session were to:

    • Address the evidence on common practices in total joint arthroplasty
    • Dispel myths and legends about these practices
    • Encourage open discussion and questions

    Click on the image above to watch Dr. Springer’s presentation on urban legends versus evidence-based medicine, and then click the images below to hear more about the evidence for or against specific practice in total joint arthroplasty from the session faculty.

    Preoperative: Blood Management, Penicillin Allergy, and Perioperative Antibiotics
    Ryan M. Nunley, MD

    Intraoperative: Skin Preps and Drapes, Antibiotic Cement, Irrigations
    Jeremy M. Gililland, MD

    Intraoperative: Drains, Tranexamic Acid, and Transfusion Triggers
    H. Del Schutte, MD

    Postoperative: Continuous Passive Motion, Venous Thromboembolism Prophylaxis, Dental Prophylaxis
    James A. Browne, MD

    Disclosures: The faculty have no disclosures relevant to their presentations.


    1. Abdel MP, Houdek MT, Watts CD, Lewallen DG, Berry DJ. Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. Bone Joint J. 2016 Apr;98-B(4):468-74. doi: 10.1302/0301-620X.98B4.37203.
    2. American Joint Replacement Registry. Fifth AJRR Annual Report on Hip and Knee Arthroplasty Data. 2019. ISSN 2375-9100 (print), ISSN 2375-9119 (online).