Emily Dodwell and the fragility of the science in orthopedic surgery

On today’s episode, I talk with Emily Dodwell of the Hospital for Special Surgery in New York.  We begin discussing her background and how she views some of the known facts about hip dysplasia, such as risk factors and current best practices for non-operative treatment, leading into variation in screening strategies around the world. We talk about a population-based study she published using data from New York state to determine the rate of surgery for hip dysplasia in infants and variations thereupon how this sheds light on the state of affairs in a highly developed region. We discuss health economics and so-called “Parent-Derived Health State Utilities,” a useful tool to evaluate the burden of treatment for patients and parents of patients  with hip dysplasia. Finally we discuss the fragility of our evidence base and a paper she coauthored looking at another measure called the fragility index which shows that the science may not be anywhere near strong enough for the decisions we make, ending on a philosophical discussion of what would it take structurally to improve the science from both a power and transparency standpoint, whether randomized control trials are truly feasible in surgery or prospective registries may be the best we will have for the foreseeable future.