Date: Sunday, October 21, 2018
Session Type: ACR/ARHP Combined Abstract Session
Session Time: 9:00AM-11:00AM
An increasing number of total joint replacement (TJR) procedures are performed as computer-assisted total joint replacement (CA-TJR). Effectiveness of computer-assisted total joint replacement (CA-TJR) compared to conventional TJR has been evaluated by multiple systematic reviews with conflicting results. We evaluated the quality of systematic reviews comparing CA-TJR to conventional TJR.
We searched MEDLINE, EMBASE, the Cochrane, and Epistemonikos to identify systematic reviews published through May 2017. One reviewer conducted title and abstract screening of all resulting citations. Full-text articles that met inclusion criteria were retrieved and assessed independently by two reviewers using the AMSTAR 2 tool (Shea et al., 2017). AMSTAR 2 has seven critical and 9 non-critical domains. Systematic reviews are rated as high (no critical or non-critical flaws), moderate (non-critical flaws only), low (1 critical flaw), or critically low quality (>1 critical flaw).
Of 384 citations originally identified, 38 systematic reviews were included (Figure 1). Based on the AMSTAR 2 tool, 37 studies were rated critically low and one study was rated low. The low rating was due to failure in meeting AMSTAR 2 criteria on the following critical domains (Figure 2): 37 (89%) reviews did not report the protocol registration; 32 (84%) studies did not justify excluding individual studies; 27 (68%) studies did not account for risk of bias in primary studies when interpreting the results; 20 (52%) failed to use comprehensive literature search strategy; 17 reviews with meta-analyses failed to justify the use of appropriate methods for statistical combination of results from randomized controlled trials (48%) and non-randomized studies (44%), and 16 (42%) meta-analyses did not use satisfactory techniques to assess risk of bias of RCTs; and 16 (42%) studies failed to report publication bias. The non-critical weaknesses are shown in figure 3.
Despite the large number of published systematic reviews about the relative effectiveness of CA-TJR, quality of these reviews was critically low, thus significantly weakening the conclusions derived from these reviews.
Figure 1: Flow Diagram of Study Selection
To cite this abstract in AMA style:Hasan M, Zhang M, Ghomrawi H. Quality of Systematic Reviews Comparing Conventional Vs. Computer-Assisted Joint Replacement [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/quality-of-systematic-reviews-comparing-conventional-vs-computer-assisted-joint-replacement/. Accessed January 24, 2021.
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