Orthopaedic trial networks.

Area of Science:

• Health Services Research
• Clinical Trials Methodology
• Orthopaedic Surgery Research

Background:

• Randomized controlled trials (RCTs) are the gold standard for evaluating health interventions but face significant barriers to implementation.
• Surgical specialties, particularly orthopaedics, have historically contributed less to the RCT literature due to funding, complexity, and recruitment challenges.
• Issues such as clinical equipoise and patient acceptability critically impact the success of surgical RCTs.

Purpose of the Study:

• To explore the role of orthopaedic networks in overcoming challenges associated with conducting RCTs in orthopaedic surgery.
• To identify strategies for improving the feasibility, efficiency, and impact of RCTs in orthopaedic clinical practice.
• To emphasize the importance of networks in enhancing patient recruitment and fostering a research culture.

Main Methods:

• This study reviews the challenges in conducting RCTs within orthopaedic surgery.
• It examines the potential of orthopaedic networks (associations, societies, research networks) to facilitate RCTs.
• The review discusses how networks can address funding, training, coordination, and dissemination issues.

Main Results:

• Orthopaedic networks offer a viable solution to the difficulties in funding and setting up RCTs.
• Networks can play a key role in identifying research priorities, training surgeons, and coordinating multi-center trials.
• Leveraging networks is essential for improving patient recruitment, a critical factor for evidence generation in orthopaedics.

Conclusions:

• Orthopaedic networks are vital for promoting a research culture and ensuring the efficient use of resources for RCTs.
• These networks are crucial for overcoming recruitment barriers and enhancing the evidence base for orthopaedic practice.
• Future strategies should incorporate networks to improve generalizability, foster collaboration, and increase the acceptance of trial findings.