[gforge]

There is though a lot of good research coming out of the US but from my understanding they can be rather expensive. Sweden has probably some of the best hip arthroplasty outcomes but the cost of these is roughly 5-10 times lower than in the states. I think the system is somewhat stacked against you, if doctors (also human beings) spend 80-100 hours/week during their residency, they expect a financial reward afterwards or no-one would agree to that.

Orthopedics is also somewhat of an odd medical specialty with lots of incentive issues and a scarcity of good clinical trials. In a study from Sydney they found that among the 50% of the surgeries that had been evaluated with randomized clinical trials (RCT), only in 50% of the cases the trials actually supported the surgery. It is though much more difficult to randomize people to surgery, doing the blue or red pill is much easier.

I'm pretty sure also that a big part of the problem is us doctors failing to identify if a patient is part of the long tail or not, i.e. does he/she not fall into a particular study's inclusion criteria or not? Hopefully we will be able to shortcut this problem with deep learning tools but as most self-driving-car enthusiast know - there is a big difference driving around in the parking lot from the open streets.