title: Traditions and myths in hip and knee arthroplasty.
abstract: OBJECTIVE
  Traditions are passed on from experienced surgeons to younger fellows and become "the right way to do it". Traditions associated with arthroplasty surgery may, however, not be evidence-based and may be potentially deleterious to both patients and society, increasing morbidity and mortality, slowing early functional recovery, and increasing cost.
  
  
  METHODS
  We identified selected traditions and performed a literature search using relevant search criteria (June 2014). We present a narrative review grading the studies according to evidence, and we suggest some lines of future research.
  
  
  RESULTS
  We present traditions and evaluate them against the published evidence. Preoperative removal of hair, urine testing for bacteria, use of plastic adhesive drapes intraoperatively, and prewarming of the operation room should be abandoned-as should use of a tourniquet, a space suit, a urinary catheter, and closure of the knee in extension. The safety and efficacy of tranexamic acid is supported by meta-analyses. Postoperatively, there is no evidence to support postponement of showering or postponement of changing of dressings to after 48 h. There is no evidence to recommend routine dental antibiotic prophylaxis, continuous passive motion (CPM), the use of compression stockings, cooling for pain control or reduction of swelling, flexion of at least 90 degrees as a discharge criterion following TKA, or having restrictions after THA. We present evidence supporting the use of NSAIDs, early mobilization, allowing early travel, and a low hemoglobin trigger for transfusion.
  
  
  CONCLUSIONS
  Revision of traditions and myths surrounding hip and knee arthroplasty towards more contemporary evidence-based principles can be expected to improve early functional recovery, thus reducing morbidity, mortality, and costs.
authors.affiliation: Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Husted
authors.forename: Kirill
authors.initials: K
authors.lastname: Gromov
authors.forename: Henrik
authors.initials: H
authors.lastname: Malchau
authors.forename: Andrew
authors.initials: A
authors.lastname: Freiberg
authors.forename: Peter
authors.initials: P
authors.lastname: Gebuhr
authors.forename: Anders
authors.initials: A
authors.lastname: Troelsen
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000592:standards*; D019645:Arthroplasty, Replacement, Knee / Q000592:standards*; D001291:Attitude of Health Personnel; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic