Do orthopaedic surgeons practice what they preach?

Good medical practice predicates a contemporary knowledge of the literature. The British edition of the Journal of Bone and Joint Surgery (JBJS [Br]) is considered one of the leading orthopaedic journals. While seeking guidance on proposed changes to departmental policy, discussion with some high-profile units raised concerns regarding the implementation of their published clinical recommendations. We intended to contact the publishing departments, to establish their routine practice with respect to the topic on which they have written. We reviewed all articles published in IBIS (Br) between January 2005 and December 2006. Target papers were those that recommended a change in practice. The originating department was contacted by telephone and communication sought from an individual not directly involved in the publication, but on whom the change in practice would impact. Seventy-nine papers; representing the work of 87 separate hospitals from 22 different countries, were identified. We found that published articles were being followed in 56% of cases, 42% were not. Our study demonstrates that a large proportion of institutions making clinical recommendations are not practising them. Have we exposed a fundamental flaw in the publication of clinical research? In conclusion, we do practice what we preach... sometimes.