Positive outcome reporting in orthopaedic literature.

Area of Science:

• Orthopedics
• Pediatric Orthopedics
• Clinical Research Methodology

Background:

• Perthes' disease (PD) involves idiopathic osteonecrosis of the proximal femoral epiphysis, with controversial treatment options and limited evidence-based approaches.
• Surgical management is common for PD, despite a lack of clear superiority among available treatments.
• Positive outcome reporting, defined as statistically significant beneficial results, can serve as a proxy for scientific rigor.

Purpose of the Study:

• To conduct a systematic literature review on Perthes' disease treatment studies.
• To test the hypothesis that positive outcome reporting is prevalent in studies concerning Perthes' disease management.

Main Methods:

• A systematic review of English-language manuscripts on Perthes' disease treatment published between January 2000 and December 2021.
• Data extraction included study characteristics, surgical vs. non-surgical approaches, treatment modalities, follow-up duration, analytical methods, and clinical recommendations.

Main Results:

• The review included 130 manuscripts, with 85% reporting positive outcomes.
• Only 8% of studies had a testable hypothesis, yet 55% recommended their treatment method.
• The positive outcome rate (85%) in PD studies exceeds that of other surgically treated disorders.

Conclusions:

• The high rate of positive outcome reporting in Perthes' disease treatment literature may overestimate treatment efficacy.
• Recommendations for treatment were often based on retrospective data without robust hypothesis testing.
• Further research is needed to establish evidence-based guidelines for Perthes' disease management.