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Principles of Designing an Orthopaedic Case-Control Study

Busse, Jason W. DC, MSc, PhD1; Obremskey, William T. MD, MPH2

doi: 10.2106/JBJS.H.01570
Design, Conduct, and Interpretation of Nonrandomized Orthopaedic Studies--A Practical Approach

Many surgical questions are not amenable to investigation with a randomized controlled trial; thus, investigators must select an appropriate observational study design. Case-control studies are relatively inexpensive and can be conducted in comparatively little time. Although there are important methodological limitations associated with this trial design, case-control studies can provide important insight into the association between one or more exposures and a specific outcome. They are particularly useful when the outcome of interest is rare or when the time to development of the outcome is long. We present an overview of the case-control study, with a focus on trial design and interpretation of results.

1Institute for Work and Health, 481 University Avenue, Suite 800, Toronto, ON M5G 2E9, Canada. E-mail address:

2Division of Orthopedic Trauma, Vanderbilt University, Medical Center East-South Tower, Suite 4200, Nashville, TN 37232-8774

Copyright © 2009 by The Journal of Bone and Joint Surgery, Incorporated
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