What are the current research gaps in orthopedic surgery?

From the Guidelines

Current research gaps in orthopedic surgery include the need for high-quality evidence to support the clinical effectiveness of various procedures, with most common elective orthopaedic interventions lacking readily available high-quality evidence, as noted in a 2021 study published in the BMJ 1. The field of orthopedic surgery faces several challenges, including the need for improved long-term outcomes data for joint replacements, particularly in younger patients who may require revision surgeries. Some of the key areas that require further research include:

• Biological approaches to cartilage regeneration and repair, which could potentially eliminate the need for artificial joint replacements
• Personalized medicine applications in orthopedics, with limited understanding of how patient-specific factors affect treatment outcomes
• Preventing and treating post-surgical complications like infection and chronic pain, which remain significant challenges
• Optimal timing and indications for many orthopedic procedures, particularly for conditions like rotator cuff tears and meniscal injuries where the benefits of surgical versus conservative management remain debated
• Rehabilitation protocols following orthopedic procedures, with uncertainty about the optimal timing, intensity, and duration of physical therapy
• Cost-effectiveness of various treatment approaches and technologies, especially as healthcare systems globally face financial constraints, as highlighted in a 2021 study published in the BMJ 1. These gaps exist partly due to the challenges of conducting long-term randomized controlled trials in surgical specialties and the rapid pace of technological advancement that often outpaces rigorous clinical evaluation, as noted in a 2019 study published in The Journal of the American Academy of Orthopaedic Surgeons 1. The most recent and highest quality study, a 2021 umbrella review of level 1 evidence published in the BMJ, emphasizes the need for an improved and more rigorous approach to the recommendation of procedures with limited evidence on their clinical effectiveness 1. This study highlights the importance of prioritizing research, especially for procedures with a limited evidence base, and for definitive randomized controlled trial designs to evaluate their clinical effectiveness. Overall, addressing these research gaps is crucial to improve patient care, cut healthcare costs, and increase societal trust in orthopaedic interventions, as emphasized in a 2021 study published in the BMJ 1.

From the Research

Current Research Gaps in Orthopedic Surgery

• The use of stem cells in tendon-bone healing is a current area of research, with studies investigating the potential of stem cells to enhance the integration of tendon and bone through biological methods 2.
• Biologic therapies, including stem cells, platelet-rich plasma, growth factors, and other biologically active adjuncts, have received increased attention in the treatment of sports medicine injuries, but there are still barriers to implementation and a need for further research 3.
• The use of stem/stromal cells in ligament repair and reconstruction is a growing area of investigation, with promising outcomes in animal models and early clinical studies, but a lack of high-level human evidence and standard-of-care controls 4.
• Clinical studies on the use of mesenchymal stem cells for treatment of tendon and ligament injuries are limited, with a need for more double-blind randomized control trials to confirm the potential of cell therapy and its advantages compared to other treatment options 5.
• Orthopedic surgery is a broad specialty with various subspecialties, but there is a need for more research in areas such as orthopedic trauma, hand, pediatrics, total joint, foot and ankle, sports medicine, and oncology 6.

Specific Areas of Research Gaps

• Tendon-bone healing: further research is needed to enhance the integration of tendon and bone through biological methods 2.
• Ligament repair and reconstruction: more high-level human evidence and standard-of-care controls are needed to confirm the potential of stem/stromal cell augmentation 4.
• Clinical application of mesenchymal stem cells: more double-blind randomized control trials are needed to confirm the potential of cell therapy and its advantages compared to other treatment options 5.
• Orthopedic subspecialties: more research is needed in areas such as orthopedic trauma, hand, pediatrics, total joint, foot and ankle, sports medicine, and oncology 6.