Dear Mr. Cuc,

I am an economist with a particular interest in statistical methods for causal inference. That is, I am interested in measuring the causal impact of economic policies.

There are plenty of methods for this purpose. A central framework is the "counterfactual approach" developed by Rosenbaum and Rubin. This methodology may be useful for measuring the impact of medical treatments or assessing their risks, and the results of these studies may be helpful for decision making.

Thanks, yes. I have been studied "Medical standards in Orthopaedsy" as the views Head of Czech standardisation from machinary products, from dangerous technologies, from processing planning in Machinary, from usage of statistic method to build deep innovations in machinary with implementing of Robotics, automatic management with full Computerised processing - but the Medical standards are similar as the games of students.....this is literature - no regulations for mandastory processing with defined "Workshop - as surgery hall with testing the minimal fucntional equipment, It support,  perfect timing planning, sequential and parallely processing, the begin with testing full mandatory documentation - Clinic Individual Plan, perfect Health status of patient, perfect storage of reserved Blood, reserved set of Implants, perfect desinfect testing hall - staff, perfect full instrument storage,.Check lists, preliminary trenagers for catastrofic situations - Stroke, blood colapsing, intensive blood streaming, Heart arythimia, perfect Anesthesiolog with statistic experienced testing, ....It should be similar as in Pilot trangering of staff - Physicians, instrument  nurses....the best implants by durability for predicted 20 years, the Orthopaed should be with minimum 150 cases of realisation surgeriesthe same types  in last 1 years, with Videorecoridng all processing in surgery hall continualy - with independt Technical sampling whole quality, technical accuracy of assembling set THA, with perfect planning the RADIOLOGICAL   CONTROLLING - with minimize increases of sumary ionisation, with interpretation in 3D by coimputer support, with perfect planning transport of patients by regulations Health and safety - including temperature, mooving from bed to transport car,  with safety  parking, with supervised to perfect patient safety position, mental well being, safety do risk fallen, perfect arrchiving all Medicaments with controlling dosage by patient weight, Age, Allergy, archiving Videorecords - the best education Musters must be analysed in details for routine similar behaviore by next surgeries.....it shoudl be similar projected as for next full Robotics versions processing - ther are absurd some duty medical activites to realised to late or in false sequentila or without immedisately technical controlling the legal quality of each partial step!  Yes, I am able to organised such "Produce of perfect orthopaedic surgeries"...but the Phyisicans should realised individual Tasks accuracy, well timing, withroutine of immediately controliing....Yes - it shoudl be Industrial processing.....without Mass of medical mistakes, as mooving in short defined Transformal Channel Input/Output with individual respects to individual patient....No by Physician Head of Genius....with gold in the hands of One Professor of Medicine only! There should be more cheap, more efficient, more safety, more sicentic implementing of  interdisciplinaire interfaces Medicine with perfect used  Technics, IT support! With minimize growing entropy in Transformal producing Channel. I am able to rescue many patients, but I need more better educated Physicians in basic Technics, technolgy processing planning, It support, statistic support, economic decision by multicriterial choice - probable in short future we need the individual patient Implants Designing in Geometry 3D as automatic clever subroutine...in Channel. ...for many orthopaedic standards (artifical Knee, Hips, skeletal details - for individual Patient)

From the Orthopaedic point of view. There are Joint Registries of different countries (Scadinavian countries, Australia, UK etc) that indicate the success rate of different prostheses. Also there are guidelines (for example in UK there are the GMC, NICE and BOA guidelines as well as the Anaesthetics Association) that are placing the criteria for the proposal of a joint replacement to patients who need it.

When I am projectant for ful automatic preparing perfect Input of Orthopadic patient till automatic realisation surgery THA with Robotics, automatic controlling the best safety Anesthesia for thw individual patient....til robotic testing of functional ability of set THA in perfect postions in patient Body - I am reesponsible for all partial views on Technician so as Medical Aspect of Lege Artis - when in the Czech Republic some orthopaed make a fatal technical medical mistakes - he said allways "In frame Lege artis some mistakes" - never detect the absency of som technical mandatory measurement, perfect intwerpretation Radillgic images by Geomtrie 3 D - he is absolote out of Technician requirements of Laws - but he says "in frame Lege artis" and such idiocy are in Czech Republic accepted by the Knowing institute too - despite there are no Based Evidenced Medicine and No respects to Lege artis - when in the medical processing are ignoring the fatal technical medical mistakes with casual heavy injured Patients including. It is scandal against púrinciples LOGICS, against Technician requirements of Laws, against the Human rights to perfect legal Health care by Directive 93/42/EEC Medical Devices. . This mistakes are full excluded in Clinics tests for the Protocol Conformity Assessment "CE" - because the Orthopadic Implants are continually controlled paralelly from Technician and Medical  Quality aspects of usage the new Orthopaedic products to Markt EU - but in fields of Providers of Health care in hospital nets EU - there are such regards to keep legal Quality of implanting are without supervising... there are only formal certification of new users - with the Performance of the right usage by the firm Videorecording from Deliever Firms, no controlling the  sufficient technician knowledges - are guaranted for medical staff from the Provider nets of Health care! It means Mass being of needless yearly heavy injured Patients with preliminary casual shorten Patient lives! There are no support from Czech Criminal Policy to stop bad illegal medical workflow in Orthopady Clinics, Radiology Clinics, etc by Mass  Useres..

I am afraid that Biology is not Engineering, although philosophically we may say that the body is a great engine, which we are still, as medics, learning about the different functions of it. Despite this there are miriads of differences in all bodies and miriads of parametres to be considered even if one does the same operation all the time. Every patient is a different individual. Every operation, although seems similar is different. So the "technicalities" of an operative procedure may be the same but have to be "applied "with different manner. The "art" is the same but the "material" different. It is the same as a painter can paint on canvas but also on fabric. There will be the same strokes for the paint to be applied but with a different way. A "young" bone is behaving in a different way than an osteoporotic bone.

Complications of any surgery and any medical practice are publiced in different papers and they are acceptable in statistical analytical ways. These percentages can be the guidence and they must be mentioned to the patient. Also every institute and every surgeon has to have audited the result of the practice and compare those to the literature. If he is lacking then he has to be retrained or even abandon the procedure that he has low success rates.  The results of the institution as well as the surgeon's have to be mentioned to the patient.

Following this the patient and the surgeon have to sign an informed consent form, and a copy can be given to the patient. The procedure and all potential benefits as well as all potential complications have to be written on the paper. Information leaflets can be given to the patient with potential references so he can search and have more information if he/she thinks that it is necessary. As the patient has also copy of the consent form it is possible that can think again by re-reading it and possibly have more questions for the surgeon, which can be answered on admission of even before surgery by mail; or even discuss all with the family members and decide not to proceed if that is the wish.

Nobody will stop complications to happen during or even after surgery. This is because we are not machines and there is not possible to eliminate them. Humans make errors, patients as well as medics. If these are not intentional and they are within the risk assessed literature then we need to accept them. We are at risk to walk and also drive but we do not stop. We carry on because we have done our individual risk assessment. Information is paramount. And something for the end, as it is fashion lately, robots will not eliminate the errors. Still humans are in charge of them and they make mistakes.

@Cuc     I agree entirely with Dr. Zafiropoulos. Human body is not a machine and it is a very difficult  task if ever possible to measure the effects of THA  using mathematical methods. That is why we use the so-called Joint Replacement Registries which give an exact picture of results and complications with different endoprostheses over the years. The most popular one is the Swedish Hip Replacement Registry since 1979. It is actualized almost each year. In this registry you may see that there are about 5 types of THA models which have stood the test of time giving prosthesis survival in over 95% of the cases on a long-term. Meanwhile, I believe there is a Czech Hip Registry too ?     Please, see links below:

https://dash.harvard.edu/bitstream/handle/1/12153012/3967250.pdf?sequence=1 

https://books.google.bg/books?isbn=1447154517