Although the evidence-based literature continues to grow, it is not always feasible for clinicians to stay proficient. Hence, many scientific journals encourage researchers to submit synthesised compilations of this nature because systematic reviews and meta-analyses provide good compendia for clinicians and researchers [6]. But this approach is only one piece in the game. Conclusive reviews are based on well-performed primary research; however, primary research also has space for improvement [7, 8]. Conclusive research is available, and thanks to modern databases, e.g., Epistemonikos as the largest source of systematic reviews, which is helpful for health-decision-making processes. These databases are broadly available and often well-synthesized and translated for daily use in clinical practice guidelines.

The ‘working evidence’ phenomenon refers to the individual clinical expertise that asserts itself as conventional wisdom in local practices. The proponent David Sacket indicated in the article, which was cited more than 20,000 times, that external clinical evidence can inform, but can never replace individual clinical expertise, and it is this expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into a clinical decision [9]. This sentiment has led to the rise of the EBP paradigm, which focuses on the individual differences among patients, their expressed needs and the local wisdom of the clinician combined with findings from external evidence literature.

Patient preferences are notably important to medical decision-making. For example, if a patient expresses chronic pain while demanding a surgical solution, EBPs indicating eccentric tendon training as a therapeutic mitigation technique are unlikely to satisfy the patient, as patient compliance is crucial to this process.

Moreover, implementing evidence into the country-specific healthcare systems is sometimes difficult. There is a huge amount of literature on inpatient care after total knee arthroplasty available. However, patients in some countries are operated on an outpatient basis and go home after surgery nowadays. Thus, evidence on treating patients in a hospital is unlikely to be of any help, e.g., the use of any training machines or walking bars in early postoperative rehabilitation.

The successful implementation of EBM requires consistently high-quality communication among stakeholders, e.g., nurses, physiotherapists, physicians and patients, as they are usually not on the same level of information on a topic.

Preoperative education, goal setting, and precautions can serve as examples. Imagine a patient may be inclined to favour total hip arthroplasty if the clinician provides accurate information regarding anticipated low pain levels after recovery, which very often leads to a more active life afterwards. In many cases, this patient would be educated by the surgeon during the pre- and post-operational consultations that deep flexion should be avoided after surgery. On the other hand, the physiotherapist may emphasise the increased risk of hip dislocation caused by excessive adduction or external rotation, whereas a nurse may separately recommend that public transport should be avoided to avoid falling. In such cases, the patient is likely to become very confused based on apparent contradictions. Moreover, the patient’s general anxiety will increase owing to the heavy emphasis on risks and avoidance. If stakeholder education in such cases were to rely on EBM but also on communication, experience and preferences of the patient, the result of a patient being afraid of arthroplasty dislocation would likely be avoided.