Facing the Evidence IM Nails vs Sliding Hip Screws and the Microbiome of Arthritic Joints.

Marc Swiontkowski

MD, FAOA

Professor, University of Minnesota

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Mohit Bhandari

FRCSC, PhD

Distinguished University Professor, Chair of Surgery, McMaster University

The discussion highlights two emerging themes in orthopaedics: the persistence of practice patterns despite clear evidence, and the provocative possibility that osteoarthritis may have a microbial dimension. A large multinational RCT (INSITE) again showed no advantage of intramedullary nails over sliding hip screws for intertrochanteric fractures, reinforcing decades of consistent evidence. Yet training environments, industry influence, and ingrained habits continue to shape practice more than data. The conversation then shifts to new research using advanced microbial sequencing in arthroplasty specimens, which revealed microbial fragments in many joints. Although causation is unproven and contamination remains plausible, the work opens questions about injections, surgical prep, and the broader microbiome. Both hosts argue that large collaboratives and thoughtful knowledge translation are essential to close old practice gaps and responsibly explore new scientific frontiers.