The maintenance of quality and integrity in clinical and basic science research depends upon peer review. This process has stood the test of time and has evolved to meet increasing work loads, and ways of detecting fraud in the scientific community. However, in the 21st century, the emphasis on evidence-based medicine and good science has placed pressure on the ways in which the peer review system is used by most journals. This paper reviews the peer review system and the problems it faces in the digital age, and proposes possible solutions. Cite this article: Bone Joint J 2014;96-B:436–41

The peer review process for the evaluation of manuscripts for publication needs to be better understood by the orthopaedic community. Improving the degree of transparency surrounding the review process and educating orthopaedic surgeons on how to improve their manuscripts for submission will help improve both the review procedure and resultant feedback, with an increase in the quality of the subsequent publications. This article seeks to clarify the peer review process and suggest simple ways in which the quality of submissions can be improved to maximise publication success. Cite this article: Bone Joint Res 2013;2:245–7

Quality outcomes from medical intervention are assumed by patients & the community. However such quality cannot be assured in every case. There are systems which can be developed which will make the safety of patients more assured. In any system of medical care, it is presumed that the practitioners who are taking care of the patient are qualified both in their basic qualification & also in their higher qualification. As well it is now accepted that appropriate credentialling occurs & that this is the purview of the hospital which will check the qualifications & currency of practice with the medical board & the higher degree & currency (participation in CPD) with the College concerned. They should also review the privileges which define the scope of practice. In orthopaedic oncology it is now essential that a practitioner has completed a higher form of training such as a Fellowship. At the current time in this country there is no process of assurance of the quality of the education program but there is continuing development in this area. Peer review & audit remains problematic. The RACS demands that surgeons participate in an appropriate audit process yearly & that this reviews outcomes rather than just complications. The participation is however voluntary. Despite this, the participation rate is greater than 94% of all surgeons. Medical boards have been requested to make participation in a quality CPD program compulsory, but have not done so, & there are no sanctions for non participation – yet. Most surgeons participate in regular morbidity & mortality meetings, but these are not truly audits of outcome. It would be wise for the Australian Sarcoma Group to develop outcome measures which could easily be collected. The desire to perform research should not be confused with audit which simply addresses quality at an appropriate expert level and which the community expects. Prospective collection & review of outcome measures will mean that trends in performance will be noted earlier. This is particularly important in adverse events. These processes have been embraced by some branches of surgery more than others. Medical outcome reviews of performance have not been developed to such an extent in most disciplines for a variety of reasons, including the fact that surgical endpoints can be more easily identified. The same principles apply, however. It is important for the profession to participate in self audit or third parties will demand it, not necessarily in a way which we might prefer

Aims. Preprint servers allow authors to publish full-text manuscripts or interim findings prior to undergoing peer review. Several preprint servers have extended their services to biological sciences, clinical research, and medicine. The purpose of this study was to systematically identify and analyze all articles related to Trauma & Orthopaedic (T&O) surgery published in five medical preprint servers, and to investigate the factors that influence the subsequent rate of publication in a peer-reviewed journal. Methods. All preprints covering T&O surgery were systematically searched in five medical preprint servers (medRxiv, OSF Preprints, Preprints.org, PeerJ, and Research Square) and subsequently identified after a minimum of 12 months by searching for the title, keywords, and corresponding author in Google Scholar, PubMed, Scopus, Embase, Cochrane, and the Web of Science. Subsequent publication of a work was defined as publication in a peer-reviewed indexed journal. The rate of publication and time to peer-reviewed publication were assessed. Differences in definitive publication rates of preprints according to geographical origin and level of evidence were analyzed. Results. The number of preprints increased from 2014 to 2020 (p < 0.001). A total of 38.6% of the identified preprints (n = 331) were published in a peer-reviewed indexed journal after a mean time of 8.7 months (SD 5.4 (1 to 27)). The highest proportion of missing subsequent publications was in the preprints originating from Africa, Asia/Middle East, and South America, or in those that covered clinical research with a lower level of evidence (p < 0.001). Conclusion. Preprints are being published in increasing numbers in T&O surgery. Depending on the geographical origin and level of evidence, almost two-thirds of preprints are not subsequently published in a peer-reviewed indexed journal after one year. This raises major concerns regarding the dissemination and persistence of potentially wrong scientific work that bypasses peer review, and the orthopaedic community should discuss appropriate preventive measures. Cite this article: Bone Jt Open 2022;3(7):582–588

Aims. The use of biologics in the treatment of musculoskeletal injuries in Olympic and professional athletes appears to be increasing. There are no studies which currently map the extent, range, and nature of existing literature concerning the use and efficacy of such therapies in this arena. The objective of this scoping review is to map the available evidence regarding the use of biologics in the treatment of musculoskeletal injuries in Olympic and professional sport. Methods. Best-practice methodological frameworks suggested by Arksey and O’Malley, Levac et al, and the Joanna Briggs Institute will be used. This scoping review will aim to firstly map the current extent, range, and nature of evidence for biologic strategies to treat injuries in professional and Olympic sport; secondly, to summarize and disseminate existing research findings; and thirdly, to identify gaps in existing literature. A three-step search strategy will identify peer reviewed and non-peer reviewed literature, including reviews, original research, and both published and unpublished (‘grey’) literature. An initial limited search will identify suitable search terms, followed by a search of five electronic databases (MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Web of Science, and Google Scholar) using keyword and index terms. Studies will be screened independently by two reviewers for final inclusion. Dissemination. We will chart key concepts and evidence, and disseminate existing research findings to practitioners and clinicians, through both peer reviewed and non-peer reviewed literature, online platforms (including social media), conference, and in-person communications. We will identify gaps in current literature and priorities for further study

Abstract. Introduction. Aseptic loosening is the most common cause of failure following cemented total knee arthroplasty (TKA) and this has been linked to poor cementation technique. We aimed to develop a consensus on the optimal technique for component cementation in TKA. Methodology. A UK based, three round, online modified Delphi Expert Consensus Study was completed focussing on cementation technique in TKA. Experts were identified as having a minimum of 5 years Consultant experience in the NHS and fulfilling any one of the following three criteria:. · A ‘high volume’ knee arthroplasty practice (>150 TKA per annum) as identified from the National joint registry (NJR). · A senior author of at least 5 peer reviewed articles related to TKA in the previous 5 years. · A named trainer for a post CCT fellowship in TKA. Results. Eighty-one experts (Round 1) and eighty experts (Round 2 and 3) completed the Delphi Study. Four domains with a total of twenty-four statements were identified. 100% consensus was reached within the cement preparation, pressurisation, and cement curing domains. 90% consensus was reached within the cement application domain. Consensus was not reached with only one statement regarding the handling of cement during initial application to the tibial and/or femoral bone surfaces. Conclusion. The CeTIKS expert consensus study presents comprehensive recommendations on the optimal technique for component cementation in TKA. Expert opinion has a place in the hierarchy of evidence and until better evidence is available these recommendations should be considered when cementing a TKA

Aims. Aseptic loosening is the most common cause of failure following cemented total knee arthroplasty (TKA), and has been linked to poor cementation technique. We aimed to develop a consensus on the optimal technique for component cementation in TKA. Methods. A UK-based, three-round, online modified Delphi Expert Consensus Study was completed focusing on cementation technique in TKA. Experts were identified as having a minimum of five years’ consultant experience in the NHS and fulfilling any one of the following criteria: a ‘high volume’ knee arthroplasty practice (> 150 TKAs per annum) as identified from the National joint Registry of England, Wales, Northern Ireland and the Isle of Man; a senior author of at least five peer reviewed articles related to TKA in the previous five years; a surgeon who is named trainer for a post-certificate of comletion of training fellowship in TKA. Results. In total, 81 experts (round 1) and 80 experts (round 2 and 3) completed the Delphi Study. Four domains with a total of 24 statements were identified. 100% consensus was reached within the cement preparation, pressurization, and cement curing domains. 90% consensus was reached within the cement application domain. Consensus was not reached with only one statement regarding the handling of cement during initial application to the tibial and/or femoral bone surfaces. Conclusion. The Cementing Techniques In Knee Surgery (CeTIKS) Delphi consensus study presents comprehensive recommendations on the optimal technique for component cementing in TKA. Expert opinion has a place in the hierarchy of evidence and, until better evidence is available these recommendations should be considered when cementing a TKA. Cite this article: Bone Jt Open 2023;4(9):682–688

This talk will initially give a brief overview of the motivations behind open access publishing and explain the practicalities of the different business models from an author's point of view. The talk will then discuss open access policy, particularly in Europe, and how the publishing landscape is constantly changing, with new initiatives and mandates being introduced all the time. Innovation in peer review such as transparent peer review and registered reports will be outlined and evaluated with examples from the BMC journals portfolio. The talk will then explain some of the funding options available to authors for open access publishing, and introduce the Springer Nature funding support service, which is available to anyone wishing to find out their options. Finally, the importance of data sharing will be discussed, as will the relatively new area of open access books

Introduction: Clinical follow-up studies are sample based, in contrast to arthroplasty register data, which refer to the entire population treated. Aim of this study is to assess the differences in revision rate to quantify bias-factors in published literature. Materials and Methods: A structured literature review of Medline-listed peer reviewed journals on examples has been performed concerning implants with sufficient material in both data sources available. Products with inferior outcome were subsumed in a subgroup. Results: The number of cases presented in peer reviewed journals are relatively low in general and show a high variability. The average revision rate in peer reviewed literature is significantly lower than in arthroplasty register data-sets. Studies published by the inventor of an implant tend to show superior outcome compared to independent publications and Arthroplasty Register data. Factors of 4 to more than 10 have been found, which has a significant impact for the results of Metaanalyses. When an implant is taken from the market or replaced by a successor there is a significant decrease in publications, which limits the detection of failure mechanisms such as PE wear or insufficient locking mechanisms. The final statement made about the product under investigation seem to follow a certain mainstream. Discussion and Conclusion: Arthroplasty Register datasets are superior to Metaanalyses of peer reviewed literature concerning revision rate and the detection of failure mechanisms. Combined reviews could reduce bias factors and thereby raise the quality of reports

Introduction. The transition from resident to registrar constitutes a steep learning curve in most medical practitioners’ careers, regardless of speciality. We aimed to determine whether a six-week orthopaedic surgical skills course could increase resident skills and confidence prior to transitioning to orthopaedic registrar within the Gold Coast University Hospital, Queensland, Australia. Materials. Unaccredited registrars, orthopaedic trainees, and orthopaedic consultants, through a departmental peer reviewed process and survey, developed a six-session course (“Registrar Academy”) that included basic knowledge and essential practical skills training for residents with an interest in becoming orthopaedic registrars. This course was implemented over a 3-month period and assessed. Mixed method quantitative and qualitative evidence was sought via a 14-item and 18-item Likert scale questionnaire coupled with open-ended questions. Ethical approval was granted by our institutions Human Research and Ethics Comittee, reference no.: HREC/16/QGC336. Results/Discussion. Results were qualitatively synthesised using quantitative and qualitative data. Thirteen residents participated in the course. All residents agreed to statements indicating they felt unprepared to work as an orthopaedic registrar and were not confident in performing various core tasks required. After completing the course, residents indicated greater confidence or comfort in all these areas and felt better prepared for the transition to registrar. There was broad approval of the course among participants. Every participant who completed the final questionnaire agreed or strongly agreed that they enjoyed the course and that it taught usable, reproducible practical skills and increased their orthopaedic knowledge. This group also uniformly agreed or strongly agreed that the course improved their patient care and patient safety. Conclusion. Residents feel unprepared for their transition to orthopaedic registrar and lack confidence in several core competencies. A supplemental “Registrar Academy” within an institution is an effective way to improve knowledge, confidence, and practical skills for residents wishing to transition to a registrar position

A literature review of bone graft substitutes for spinal fusion was undertaken from peer reviewed journals to form a basis for guidelines on their clinical use. A PubMed search of peer reviewed journals between Jan 1960 and Dec 2009 for clinical trials of bone graft substitutes in spinal fusion was performed. Emphasis was placed on RCTs. Small and duplicated RCTs were excluded. If no RCTs were available the next best clinical evidence was assessed. Data were extracted for fusion rates and complications. Of 929 potential spinal fusion studies, 7 RCTs met the inclusion criteria for BMP-2, 3 for BMP-7, 2 for Tricalcium Phosphate and 1 for Tricalcium Phosphate/Hydroxyapatite (TCP/HA). No clinical RCTs were found for Demineralised Bone Matrix (DBM), Calcium Sulphate or Calcium Silicate. There is strong evidence that BMP-2 with TCP/HA achieves similar or higher spinal fusion rates than autograft alone. BMP-7 achieved similar results to autograft. 3 RCTs support the use of TCP or TCP/HA and autograft as a graft extender with similar results to autograft alone. The best clinical evidence to support the use of DBMs are case control studies. The osteoinductive potential of DBM appears to be very low however. There are no clinical studies to support the use of Calcium Silicate. The current literature supports the use of BMP-2 with HA/TCP as a graft substitute. TCP or HA/TCP with Autograft is supported as a graft extender. There is not enough clinical evidence to support other bone graft substitutes. This study did not require ethics approval and no financial support was received

Introduction: Clinical follow-up studies are sample based, in contrast to arthroplasty register data, which refer to the entire population treated. Aim of this study is to assess the differences in revision rate to quantify bias-factors in published literature. Materials and Methods: A structured literature review of Medline-listed peer reviewed journals concerning the STAR Total Ankle Replacement have been conducted. The published results from clinical follow up studies have been compared to Arthroplasty register Results: Results: 24% of all papers were published by the inventor of the implant. These publications show a 3,4 times lower revision rate compared to independent studies and a 4,6 times lower revision rate compared to Register based publications. The cumulative revision rate per 100 observed component years of register based publications is 1,36 times higher compared to independent clinical studies. The difference is statistically not significant. Pooling the published data from all follow up studies the impact of the studies published by the inventor leads to a statistically significant bias. Discussion and Conclusion: Publications by the inventor of the implant are overrepresented in peer reviewed scientific journals. This bias has a statistically significant impact on the final result of a Metaanalyses. Arthroplasty Register data are able to detect bias factors and lead to a better quality of assessments concerning the outcome of arthroplasty

You have a great research question or an idea for an innovation that will change your field. You have worked tirelessly to develop the project and are excited with the outcome. Now it is time to disseminate your findings to the world. This talk will give some insight into how to maximise the impact of your writing to reach the largest possible audience. It will discuss what makes a great paper, and provide pointers for navigating the editorial process, from your initial interactions with the editor to handling the sometimes-difficult process of peer review

Summary. Biomechanical studies comparing fixation constructs are predictable and do not relate to the significant clinical problems. We believe there is a need for more careful use of resources in the lab and better collaboration with surgeons to enhance clinical relevance. Introduction. It is our impression that many biomechanical studies invest substantial resources studying the obvious: that open reduction and internal fixation with more and larger metal is stronger. Studies that investigate “which construct is the strongest?” are distracted from the more clinically important question of “how strong is strong enough?”. The aim of this study is to show that specific biomechanical questions do not require formal testing. This study tested our hypothesis that the outcome of a subset of peer reviewed biomechanical studies comparing fracture fixation constructs can be predicted based on common sense with great accuracy and good interobserver reliability. Patients & Methods. Between 2000 and 2012, we found 254 peer reviewed biomechanical studies in prestigious orthopaedic journals comparing construct ‘A’ versus construct ‘B’ to evaluate load to failure in order to determine ‘which construct is the strongest?’. Eleven studies comparing fracture fixation constructs were randomly selected from different journals based on our sense that the answer was obvious prior to performing the study. Three-hundred independent observers; including orthopaedic- and general- surgeons affiliated with the Science of Variation Group (. www.scienceofvariation.org. ), predicted the outcome of these biomechanical studies. Observers were presented the original published illustrations of different treatment modalities and were asked to answer one question: “which construct is the strongest?” Sensitivity, specificity and accuracy were calculated according to standardised formulas. The agreement among the observers was calculated by using a multirater kappa, described by Siegel and Castellan. The kappa values were interpreted as proposed by Landis and Koch. Results. Accuracy was the same or greater than 80% for all studies except for study 1. The level of experience had no influence on the accuracy of predicting outcomes. Sensitivity averaged 84%, ranging from 60% (for study 1) to 99% (for study 7), specificity 86%, ranging from 60% (for study 1) to 99% (for study 7), and accuracy averaged 86% from 60% (for study 1) to 99% (for study 7). The overall categorical rating of inter-observer reliability according to Landis and Koch was moderate (κ = 0,53; SE = 0.01), ranging from κ = 0,03 (SE = 0.01) to κ = 0,95 (SE = 0.01). Analyses of SOVG subgroups identified excellent agreement among Canadian surgeons. Moderate and substantial agreement were found in most of other subgroups: ranging from first year medical students to specialists 20 years or more in practice; and specialists who practice in Australia, Europe and United States. Study 5 was easiest to predict based on common sense (Accuracy 97%, inter-observer reliability 0,88). Study 1 was predicted with least accuracy 61% and the lowest kappa value 0,04. Conclusions. The outcomes of biomechanical studies comparing fracture reduction and fixation constructs are highly predictable with good inter-observer reliability

Background The internet is an increasingly utilised resource for accessing information regarding a variety of heath conditions. YouTube is a popular video sharing platform used to both seek and distribute information online. Materials & Methods. A search for ‘scoliosis’ was carried out using YouTube's search engine and data was collected on the first fifty videos returned. A JAMA score (to determine currency, authorship, source and disclosure) and scoliosis specific score (that measures the amount of information on the diagnosis and treatment options as devised by Mathur et al in 2005; scored 0–32) was recorded for each video to measure quality objectively. Additionally the number of views, number of comments and feedback positivity was documented for each. Data analysis was conducted using R 3.1.4/R Studio 0.98 with control for the age of each video in analysis models. Results. The average number of views per video was 71,152 with an average length of 7 minutes 32 seconds. Thirty six percent of the videos fell under the authorship category of personal experience. The average JAMA score was 1.32/4 and average scoliosis specific score was 5.38/32. There was a positive correlation between JAMA score and number of views P=0.003. However in contrast there was a negative correlation between scoliosis specific score and number of views P=0.01. Conclusions. Online health information has historically been poor and our study shows that in an environment like YouTube which lacks a peer review process, the quality of scoliosis information is low. Further work is needed to determine whether accessing information on YouTube can play a role in patient care other than simple education pertaining to the disease and its management. Level of Evidence. Health Services Study Level 3

Unicompartmental knee arthroplasty (UKA) has a long history that extends back nearly as far as the first tricompartmental designs. While initial results were erratic, with a greater understanding of patient selection and surgical techniques, more consistent and favorable results have been reported. While there has been somewhat of a resurgence in interest in UKA, the percentage of primary knee arthroplasties that are unicompartmental hovers around 6–8%. It is my belief that you should be doing more!. Several peer review studies suggest that with both fixed and mobile bearing designs, survivorship exceeds 90% at ten year. In our own initial series of 62 fixed bearing medial UKA, survivorship was 90% at 20 years. UKA is an outstanding option for younger patients, who are amongst the most challenging to satisfy with a TKA. In a cohort of patients < 55 years old, Biswas et al. reported a mean KSS of just over 95 points and a mean UCLA activity score of 7.5. This is opposed to the report by Parvizi et al. who suggested 1/3 of young, active patients reported residual symptoms and limitations following modern TKA. Most data suggests that UKA is a less morbid procedure than TKA. In a retrospective review of 605 UKA compared to 2235 TKA, Brown et al. found the risk of complications was 11% vs. 4.3% favoring UKA with a shorter length of stay and risk of discharge to an extended care facility, which also translates into lower costs for our health care system. Finally, in the only randomised study that I am aware of that has compared UKA and TKA, UKA was associated with significantly better survivorship (90% vs. 79%). Further, UKA was associated with better ROM and functional scores at 5 and 15 years. Finally, recovery with UKA was faster and the risk of peri-operative complications was lower

Synovasure has been designed and validated for use in the diagnosis of periprosthetic joint infection (PJI). It has a reported sensitivity of 97.4% (CI 86.1–99.6%) and specificity of 95.8% (CI 90.5–98.6%), higher than the variable results reported for aspiration by most units. At a cost of £500 per test, we aimed to establish cost-effectiveness and diagnostic accuracy, to determine its role in routine practice. We developed a protocol for pre-operative aspiration or intra-operative use. Prerequisites for entry were a high index of clinical suspicion for PJI and equivocal standard investigations. All cases were discussed at the lower limb arthroplasty MDT and approved only if use would change clinical management. Over 15 months, 36 tests were approved for 22 aspirations (5 hip, 17 knee) and 14 intra-operative cases (7 hip, 7 knee). 10/36 had undergone previous revision surgery. 35/36 cases complied with the protocol. All 22 Synovasure aspirations were negative, corresponding to the microbiology in all but one case; thought to be a contaminant. In the intra-operative group there was one true positive and 12 true negative tests, giving a sensitivity of 100% (95% CI 2.5–100%) and a specificity of 100% (95% CI 73.5–100%). Synovasure influenced decision making in 34/36 procedures. One test failed and in another there was evidence of frank infection. In 11 cases no surgery was performed versus a potential two-stage revision and in 21 cases a single rather than two-stage revision was performed. Resulting in estimated savings of £686,690, offset against a cost of £18,000. The Synovasure test was found to be sensitive and specific and can aid decision-making particularly in complex cases with an equivocal diagnosis of PJI. The use of this test through a robust protocol driven peer review MDT process not only reduces patient morbidity but drives significant efficiency savings