Empiric data and theoretical arguments suggest an alternative randomized clinical trial (RCT) design, called expertise-based
RCT, has enhanced validity, applicability, and ethical integrity compared with conventional RCT. Little is known, however,
about whether physicians will participate in an expertise-based RCT. In a cross-sectional survey of Canadian orthopaedic surgeons,
we evaluated preference for and willingness to participate in an expertise-based versus a conventional RCT if given the opportunity
to participate in a trial investigating the effectiveness of high tibial osteotomy versus unicompartmental knee arthroplasty.
Using an electronic survey (©2005 SurveyMonkey.com), we invited all 767 members of the Canadian Orthopaedic Association (2005)
to participate; 276 surgeons completed the questionnaire (37.5% response rate). One hundred two surgeons (53.4%) were willing
to participate in an expertise-based RCT compared with 35 surgeons (18.3%) willing to participate in a conventional RCT. Ninety-seven
surgeons (52.4%) strongly or moderately preferred the expertise-based design compared with 25 (13.5%) who preferred the conventional
design. For the clinical example we presented, the majority of Canadian orthopaedic surgeons were willing to participate in
and preferred the expertise-based design. The expertise-based randomized clinical trial design may overcome some of the barriers
to conducting clinical trials in orthopaedic surgery and improve the validity of their conclusions.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research, and that informed consent for participation in the study
was obtained.