Landmark Papers
A curated evidence library of practice-changing orthopaedic studies — themed summaries with key findings, clinical implications, critical appraisal and exam points, each linked to the original paper.
Hip · 6
AOANJRR Annual Report
Australian Orthopaedic Association National Joint Replacement Registry Annual Report
AOANJRR · AOANJRR · 2023
The 2023 AOANJRR Annual Report evaluates over two decades of nationwide hip arthroplasty data, documenting real-world implant survivorship, fixation methods, bearing surfaces, and primary modes of failure. It demonstrates the clinical superiority of highly cross-linked polyethylene, details the increased revision risk linked to large-head metal-on-metal couples and modular junctions, and highlights hybrid and cemented fixation as protective against early periprosthetic femoral fracture in older cohorts.
Read summaryHighly Cross-Linked Polyethylene
Highly Cross-Linked Polyethylene in Total Hip Arthroplasty
Kurtz SM · Biomaterials · 2011
This seminal systematic review by Kurtz and colleagues demonstrated that first-generation highly cross-linked polyethylene (HXLPE) dramatically lowers in vivo wear and decreases the risk of periprosthetic osteolysis by 87% compared to conventional polyethylene in total hip arthroplasty.
Read summaryMetal-on-Metal Pseudotumours
Pseudotumours associated with metal-on-metal hip resurfacings
Pandit H · J Bone Joint Surg Br · 2008
This seminal retrospective case series described the clinical, radiological, and histological presentation of soft-tissue pseudotumours in patients following metal-on-metal hip resurfacing arthroplasty. It established pseudotumours as a primary failure mode of metal-on-metal bearings, highlighting that they occur predominantly in women and are mediated by excessive wear debris and cell-mediated hypersensitivity.
Read summaryPaprosky Classification
Classification of femoral defects in revision total hip arthroplasty
Paprosky WG · Instr Course Lect · 1994
The Paprosky femoral defect classification system categorises proximal and diaphyseal femoral bone loss in revision total hip arthroplasty to guide stem selection and predictable distal bypass fixation.
Read summaryLewinnek Safe Zone
Dislocations after total hip-replacement arthroplasties
Lewinnek GE · J Bone Joint Surg Am · 1978
In this landmark retrospective study of 300 primary total hip arthroplasties, Lewinnek and colleagues established the classic acetabular component 'safe zone'—defined as 40° ± 10° of radiographic inclination and 15° ± 10° of radiographic anteversion—which was associated with a significant reduction in post-operative prosthetic dislocation.
Read summaryCharnley Low Friction Arthroplasty
Arthroplasty of the Hip: A New Operation
Charnley J · Lancet · 1961
Sir John Charnley describes the initial concept and surgical technique of low-friction total hip arthroplasty combining polymethylmethacrylate (PMMA) fixation with a small femoral head articulating against a synthetic socket. This landmark paper founded modern hip arthroplasty by establishing biomechanical friction reduction and acrylic cement grouting as viable clinical strategies.
Read summaryKnee · 4
TOPKAT Trial
Total or Partial Knee Arthroplasty Trial (TOPKAT)
Beard DJ · Lancet · 2019
The landmark TOPKAT multicentre randomised controlled trial demonstrated that for isolated medial compartment knee osteoarthritis, partial knee replacement (PKR) provides equivalent clinical outcomes to total knee replacement (TKR) at 5 years, with marginally better health-related quality of life, lower costs, and similar revision rates.
Read summaryMSIS Criteria for PJI
The 2018 Definition of Periprosthetic Hip and Knee Infection
Parvizi J · J Arthroplasty · 2018
Parvizi and colleagues developed and validated an updated, evidence-based weighted scoring definition for periprosthetic joint infection (PJI) following hip and knee arthroplasty. By incorporating modern biomarkers such as alpha-defensin and D-dimer alongside traditional criteria, this scoring system achieved 97.7% sensitivity and 99.5% specificity, outperforming earlier consensus definitions.
Read summaryKANON ACL Trial
Treatment of Acute Anterior Cruciate Ligament Tears with or without Reconstruction
Frobell RB · N Engl J Med · 2010
The landmark KANON trial demonstrated that structured rehabilitation with optional delayed ACL reconstruction yields patient-reported outcomes at two years equivalent to early surgical reconstruction in young, active non-professional athletes.
Read summaryTwo-Stage Exchange for PJI
Two-Stage Exchange Arthroplasty for Chronic Periprosthetic Hip and Knee Infection
Insall JN · J Bone Joint Surg Am · 1983
This foundational landmark study introduced the staged surgical protocol for infected total knee arthroplasty, demonstrating that thorough debridement and delayed reimplantation following parenterally administered targeted antibiotics could eradicate chronic infection while preserving a functional joint.
Read summaryTrauma · 10
HEALTH Trial
Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture
HEALTH Investigators · N Engl J Med · 2019
In this international, multicentre randomized trial involving ambulatory patients aged 50 or older with displaced intracapsular hip fractures, total hip arthroplasty (THA) showed no significant difference compared to hemiarthroplasty (HA) in the risk of secondary hip operations at 24 months, while delivering only minor, clinically unimportant functional advantages and a trend toward increased dislocations.
Read summaryATLS Protocol
Advanced Trauma Life Support
American College of Surgeons Committee on Trauma · ACS · 2018
The Advanced Trauma Life Support (ATLS) protocol, established by the American College of Surgeons Committee on Trauma, provides a standardised, prioritized ABCDE algorithm for the initial assessment, resuscitation, and stabilization of multiply injured trauma patients.
Read summaryFAITH Trial
Fracture Fixation in the Operative Management of Hip Fractures
FAITH Investigators · Lancet · 2017
The FAITH trial was a large international randomised controlled trial demonstrating that a sliding hip screw did not significantly reduce the 24-month revision surgery rate compared to multiple cancellous screws for intracapsular femoral neck fractures in patients aged 50 and older, though distinct complication profiles emerged between implants.
Read summaryFLOW Trial
A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds
FLOW Investigators · N Engl J Med · 2015
In this international 2x3 factorial randomised trial of 2,447 patients with open fractures, normal saline demonstrated lower reoperation rates than castile soap, while irrigation pressure (high, low, or very low gravity flow) showed no significant difference in clinical outcomes.
Read summarySPRINT Trial
Reamed versus Unreamed Intramedullary Nailing of Tibial Fractures
SPRINT Investigators · J Bone Joint Surg Am · 2008
The SPRINT trial demonstrated that reamed intramedullary nailing significantly reduces the risk of secondary reoperations to promote union in closed tibial shaft fractures compared to unreamed nailing, with no significant difference observed in open fractures.
Read summaryLEAP Study
An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries
Bosse MJ · N Engl J Med · 2002
This prospective multicentre study compared functional recovery between limb salvage and primary amputation in severe lower-extremity trauma, finding equivalent two-year functional outcomes alongside substantial persistent disability in both cohorts.
Read summaryDamage Control Orthopaedics
Damage Control Orthopaedics: Evolving Concepts in the Treatment of Patients Who Have Sustained Orthopaedic Trauma
Pape HC · Instr Course Lect · 2002
This seminal review outlines the principles of Damage Control Orthopaedics (DCO), establishing that physiologically unstable or borderline polytrauma patients should undergo rapid provisional fracture stabilization rather than early definitive fixation to prevent exacerbating the systemic inflammatory response.
Read summaryTile Pelvic Classification
Fractures of the Pelvis and Acetabulum
Tile M · Williams & Wilkins · 1984
Marvin Tile introduced a biomechanically driven classification system for pelvic ring disruptions based on the structural integrity of the posterior sacroiliac tension band, dividing injuries into stable (Type A), rotationally unstable but vertically stable (Type B), and completely unstable with rotational and vertical disruption (Type C). This landmark concept shifted pelvic trauma management from descriptive eponyms to stability-guided resuscitation and definitive fixation strategies.
Read summaryGustilo-Anderson Classification
Prevention of Infection in the Treatment of One Thousand and Twenty-five Open Fractures of Long Bones
Gustilo RB · J Bone Joint Surg Am · 1976
This seminal study introduced the 3-tiered Gustilo-Anderson classification for open long-bone fractures and proved that immediate surgical debridement, secondary closure, and routine prophylactic antibiotics significantly reduce deep infection rates.
Read summaryGarden Classification
Low-angle Fixation in Fractures of the Femoral Neck
Garden RS · J Bone Joint Surg Br · 1961
Garden introduced a four-stage classification of intracapsular femoral neck fractures based on fracture completeness and displacement relative to medial compression trabeculae, evaluating outcomes following low-angle internal fixation.
Read summary