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An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summary of evidence Open Access (recommended)

Descriptions

Resource type(s)
Journal Article
Keyword
Overview of systematic review, total joint arthroplasty, computer-assisted surgery
Rights
Attribution-NonCommercial 3.0 United States

Creator
Hasan, Mohamed Mosaad Ismail
Zhang, Manrui
Beal, Matthew
Ghomrawi, Hassan
Abstract
Background Systematic reviews (SRs) of computer-assisted (CA) total knee arthroplasty (TKA) and total hip arthroplasty (THA) report conflicting evidence on its superiority over conventional surgery. Little is known about the quality of these SRs; variability in their methodological quality may be a contributing factor. We evaluated the methodological quality of all published SRs to date, summarized and examined the consistency of the evidence generated by these SRs.Methods We searched four databases through December 31, 2018. A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) was applied to assess the methodological quality. Evidence from included meta-analyses on functional, radiological and patient-safety outcomes was summarized. The corrected covered area was calculated to assess the overlap between SRs in including the primary studies.Results Based on AMSTAR 2, confidence was critically low in 39 of the 42 included SRs and low in 3 SRs. Low rating was mainly due to failure in developing a review protocol (90.5%); providing a list of excluded studies (81%); accounting for risk of bias when discussing the results (67%); using a comprehensive search strategy (50%); and investigating publication bias (50%). Despite inconsistency between SR findings comparing functional, radiological and patient safety outcomes for CA and conventional procedures, most TKA meta-analyses favored CA TKA, whereas most THA meta-analyses showed no difference. Moderate overlap was observed among TKA SRs and high overlap among THA SRs.Conclusions Despite conclusions of meta-analyses favoring CA arthroplasty, decision makers adopting this technology should be aware of the low confidence in the results of the included SRs. To improve confidence in future SRs, journals should consider using a methodological assessment tool to evaluate the SRs prior to making a publication decision.
Original Bibliographic Citation
Hasan MM, Zhang M, Beal M, et al. An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summaryof evidence. BMJ Surg Interv Health Technologies2020;2:e000016. doi:10.1136/bmjsit-2019-000016
Related URL
Publisher
BMJ Journals
Date Created
2020
Language
English
Subject: MESH
Arthroplasty, Replacement, Knee
Arthroplasty, Replacement, Hip
Surgery, Computer-Assisted
Meta-Analysis
DOI
10.1136/bmjsit-2019-000016

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