The goal of evidence-based orthopedics (EBO) is to provide the most efficacious interventions to improve patient quality of life and surgical outcomes. The practice of EBO involves a triumvirate of best available evidence, surgical expertise, and patient preferences. To identify best available evidence, one must have knowledge of the hierarchy of surgical evidence and appreciate the rationale for its structure. The development of several evaluative instruments and guidelines has helped surgeons by outlining the key elements of studies that impact the validity of evidence and its magnitude of effect on treatment recommendations. There has been a gradual improvement over the past decade in the methodological quality of the orthopedic literature which has been matched with a growing willingness of surgeons to utilize study results in their surgical decision-making. Thus, over a very short time span, EBO has improved best practice and accountability of the field and continues to have a growing impact internationally.