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Full list of author information is available at the end of the articleIntroduction There is an increasing awareness and application of evidence-based medicine (EBM) to guide clinical practice and enhance patient care in many medical and surgical spe-cialties- and orthopaedic surgery is no exception (Dijkman et al. 2010; Panesar et al. 2010). Accordingly, forums such as journal clubs and society meetings, aimed at equipping the next generation of practitioners with skills to critically appraise the literature, are becoming more commonplace (Dirschl et al. 2003). Although it is clear how and why studies of low quality fail to influence clinical practice, what remains a conundrum is the lack of practice changes in the setting of high quality evidence