Situational Ethics of Study Designs for Orthopaedic Surgery Interventions in Children With Cerebral Palsy

Tamer A. El-Sobky, MD; Mohamed El-Sayed, MD


Curr Orthop Pract. 2019;30(2):178-180. 

In This Article


  • While short-term RCTs of major orthopaedic interventions are ethically appealing, they are not credible in terms of evidence.

  • Although long-term follow-up RCTs of major orthopaedic interventions are able to provide reliable evidence, they are ethically challenged.

  • There is plenty of room for long-term prospective case series of major orthopaedic interventions to provide credible evidence and simultaneously conform to ethical standards.

  • Well-conducted systematic reviews or meta-analyses can help researchers identify the current deficiencies and direct future research strategies.

  • One umbrella formula or design for implementation of RCT(s) in medical and surgical clinical studies probably does not exist.

  • The ethical principles of medical practice are clear and binding, and the hierarchy of evidence-based medicine is a recognizable achievement. However, both ethics and evidence must be interpreted contextually and are subject to the variables of the involved clinical setting.