Myth vs Tradition – Total joint Replacement

Traditions can sometimes contradict existing evidence, resulting in myths: such as “this was the best remedy yesterday, and it is still the best treatment now.” In the field of Total joint replacements (TJR), there are myths that are being practiced but do not know whether it is true or not. The consequences of continuing myths could result in additional pain, infections, blood loss, morbidity, and mortality for patients, as well as higher costs.

Husted et al.(2014) offered an insightful review that explores preoperative, intraoperative, and postoperative traditions during joint replacement surgery and compares them to published research. The authors demonstrated that hair removal before to surgery, urine testing for bacteria, intraoperative use of plastic adhesive drapes, pre-warming of the operating room, use of a tourniquet, a space suit, and a urinary catheter should all be avoided. Similarly, there is no evidence to justify delaying washing or changing bandages until after 48 hours of surgery. There is also no evidence to support the use of routine dental antibiotic prophylaxis, continuous passive motion (CPM), compression stockings, cooling for pain relief or swelling reduction, flexion of at least 90 degrees as a discharge criterion after TKA, or having restrictions after THA.

After all, according to the American astronomer and astrophysicist Carl Sagan: “absence of evidence is not evidence of absence”. On the other hand, Dr Sagan stated that “it is better to light a candle than to curse at the darkness”. Ultimately, the authors made a strong proposal that revising the myths and traditions around hip and knee arthroplasty in favor of more relevant evidence-based approaches can improve early functional recovery, lowering morbidity, mortality, and the costs.

This is an interesting article from surgical and patient’s point of view. But it is always compelling to have new knowledge.

Article Link:

Husted, H., Gromov, K., Malchau, H., Freiberg, A., Gebuhr, P., & Troelsen, A. (2014). Traditions and myths in hip and knee arthroplasty. Acta orthopaedica, 85(6), 548–555.


This article was written by MM Raihan as part of an ongoing series of scientific communications written and curated by BioTrib’s Early Stage Researchers.

Raihan is researching In-situ Measurement of Nano-scale Wear Utilising Advanced Sensors at University of Leeds, UK.