Reporting bias in orthopaedic science-Are we telling the whole story?

Hirschmann MT; Prill R; Herbst E; Milano G; Musahl V

Abstract

Orthopaedic congresses and journals are dominated by positive results, creating the impression that modern surgical techniques yield uniformly excellent outcomes. In reality, complications, suboptimal results, and abandoned techniques remain underreported-a reflection of outcome reporting bias (ORB) and publication bias. Professional incentives, reputational concerns, and competitive pressures favour success stories while discouraging the publication of negative findings. Yet, these data are crucial for scientific progress and patient care, offering lessons that help avoid repeated mistakes. This editorial calls on authors, reviewers and editors to actively promote transparency and give equal opportunity to rigorously conducted studies with poor or negative outcomes. Key measures include prospective trial registration, adherence to preregistered protocols, and use of tools such as ROB, ROBINS-I, ORBIT and funnel plots to detect and mitigate bias. True progress in orthopaedic surgery requires an honest, balanced narrative-one that values both success and failure. Only by addressing ORB and publication bias can we restore trust in the scientific record and fulfil our ethical obligation to patients.