Orthopedics is the specialty that learned to prevent the damage, not just repair it.
In December 1996, The Lancet published a trial in women with weak bones. The women were past menopause and had low bone density. Each had already broken at least one bone in her spine. The trial asked whether a pill could stop the next break. It gave 2,027 of these women a daily pill, alendronate, or a placebo, for three years. New fractures showed on spine X-rays in 8.0% of the women on the pill, against 15.0% on placebo. Fractures the women noticed themselves fell from 5.0% to 2.3%. Hip and wrist fractures fell by about half as well. Side effects, including stomach problems, were no more common than on placebo. A broken bone could now be prevented, not only mended.
Eleven years later, in November 2007, the New England Journal of Medicine published a trial in people who had just broken a hip. Death rates rise after a broken hip. The trial asked whether a bone drug could change what came next. It gave 2,127 patients, with an average age of 74.5, a yearly infusion of zoledronic acid or a placebo. The first infusion came within 90 days of the operation that repaired the hip. Every patient also took vitamin D and calcium. Over about two years, 8.6% of the patients on the drug had a new fracture, against 13.9% on placebo. Deaths fell too. Of the patients on the drug, 9.6% died, against 13.3% on placebo. That is 28% fewer deaths. The main side effects were fever, aching muscles and bone pain. Treating the bone after the operation had kept patients alive.
Six years later, in October 2013, the same journal published a trial in teenagers with a curved spine. Scoliosis can keep curving while a teenager grows. A curve of 50 degrees is the usual threshold for surgery. Doctors prescribed back braces to stop the curve, but nobody agreed whether a brace helped. The trial followed 242 teenagers. Some were given a brace or careful watching at random, and the rest chose. Those with a brace were told to wear it at least 18 hours a day. The trial was stopped early, because the brace worked. Of the teenagers with a brace, 72% finished growing without the curve reaching 50 degrees, against 48% of those who were watched. The more hours they wore the brace, the better it worked. A brace could spare a teenager an operation on the spine.
These are three of the thousands of studies that shaped modern orthopedics. They taught orthopedics that a daily pill could nearly halve new spine fractures, that a yearly infusion after a broken hip could prevent the next fracture and save lives, and that a brace could spare a teenager an operation on the spine, and each time the answer was in a paper years before it was in a textbook.
It is still happening. Recently, in July 2026, The Lancet published a trial in older people who had broken a hip. Some of them are treated with a whole new hip joint. The most common early problem after that operation is a dislocation of the new joint. A newer design of hip socket, called dual mobility, was built to make the joint more stable. No trial had tested it. The trial gave 1,600 patients aged 65 or older, at 44 hospitals in Sweden and the UK, either the new socket or the standard one. Within a year, 1.3% of the patients with the new socket had a dislocation, against 4.2% with the standard one. Surgical complications of any kind fell as well. A better socket had prevented the damage before it happened. Practice follows the literature as it goes. It is a good culture. It has exactly one cost.
The literature grows faster than anyone can read it.
Across the medical topics an orthopedic surgeon needs to stay up to date on, from osteoarthritis treatment and ACL reconstruction to spinal fusion and fracture healing, around 300 full-text papers now arrive every week. That is about 1,300 a month, and more than 15,000 a year. Osteoarthritis treatment alone is 57 of each week’s 300. Low back pain is 40. These are not press releases or opinion pieces. They are the same kind of paper as the alendronate trial and the brace trial, and somewhere in each week’s 300 are the handful that will change a prescription.
It is tempting to believe that experience closes the gap, that twenty years of clinic teach what the papers teach. The evidence points the other way. A systematic review of 62 studies found that in most of them, more years in practice went with lower adherence to current standards of care. Experience is not what keeps an orthopedic surgeon current. Reading is. And reading is the one thing the week does not have room for.
So we built the tool you need to stay up to date.
We summarise the latest research for you and send it directly to your email inbox, every week, or whenever you choose.
A dual mobility hip cup cut dislocations after hip fracture surgery from 4.2% to 1.3%
TakeawayIn 1,566 people aged 65 or older given a total hip replacement for a displaced femoral neck fracture, a dual mobility cup led to a dislocation within a year in 1.3%, against 4.2% with a standard cup.
Dislocation is the most common early surgical complication when a hip fracture is treated with total hip replacement. Dual mobility cups were developed to increase joint stability, but no randomised trial had tested them. This pragmatic, registry-based trial at 20 Swedish and 24 UK hospitals randomised 1,600 people aged 65 or older with a displaced femoral neck fracture to a dual mobility or a standard cup.
- •Dislocation within 1 year: 1.3% (10 of 779) with dual mobility vs 4.2% (33 of 787) with a standard cup; adjusted hazard ratio 0.27 (95% CI 0.13 to 0.56), P < 0.0001.
- •Any surgical complication: substantially reduced with dual mobility.