Clinical Orthopaedics and Related Research

, Volume 466, Issue 7, pp 1734–1744

Orthopaedic Surgeons Prefer to Participate in Expertise-based Randomized Trials

  • Elzbieta Bednarska
  • Dianne Bryant
  • P. J. Devereaux
  • for the Expertise-Based Working Group
Original Article

DOI: 10.1007/s11999-008-0273-9

Cite this article as:
Bednarska, E., Bryant, D., Devereaux, P.J. et al. Clin Orthop Relat Res (2008) 466: 1734. doi:10.1007/s11999-008-0273-9


Empiric data and theoretical arguments suggest an alternative randomized clinical trial (RCT) design, called expertise-based RCT, has enhanced validity, applicability, and ethical integrity compared with conventional RCT. Little is known, however, about whether physicians will participate in an expertise-based RCT. In a cross-sectional survey of Canadian orthopaedic surgeons, we evaluated preference for and willingness to participate in an expertise-based versus a conventional RCT if given the opportunity to participate in a trial investigating the effectiveness of high tibial osteotomy versus unicompartmental knee arthroplasty. Using an electronic survey (©2005, we invited all 767 members of the Canadian Orthopaedic Association (2005) to participate; 276 surgeons completed the questionnaire (37.5% response rate). One hundred two surgeons (53.4%) were willing to participate in an expertise-based RCT compared with 35 surgeons (18.3%) willing to participate in a conventional RCT. Ninety-seven surgeons (52.4%) strongly or moderately preferred the expertise-based design compared with 25 (13.5%) who preferred the conventional design. For the clinical example we presented, the majority of Canadian orthopaedic surgeons were willing to participate in and preferred the expertise-based design. The expertise-based randomized clinical trial design may overcome some of the barriers to conducting clinical trials in orthopaedic surgery and improve the validity of their conclusions.

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Elzbieta Bednarska
    • 1
  • Dianne Bryant
    • 2
    • 3
  • P. J. Devereaux
    • 4
  • for the Expertise-Based Working Group
    • 5
  1. 1.Faculty of Health SciencesMcMaster UniversityHamiltonCanada
  2. 2.Faculty of Health SciencesUniversity of Western OntarioLondonCanada
  3. 3.Department of Clinical Epidemiology & BiostatisticsMcMaster UniversityHamiltonCanada
  4. 4.Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
  5. 5.HamiltonCanada

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