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Wall PDH, Richards BL, Sprowson A, Buchbinder R, Singh JA. Do outcomes reported in randomised controlled trials of joint replacement surgery fulfil the OMERACT 2.0 Filter? A review of the 2008 and 2013 literature. Syst Rev 2017; 6:106. [PMID: 28558822 PMCID: PMC5450048 DOI: 10.1186/s13643-017-0498-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/10/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND It is not known, whether outcome reporting in trials of total joint arthroplasty in the recent years is adequate or not. Our objective was to assess whether outcomes reported in total joint replacement (TJR) trials fulfil the Outcome Measures in Rheumatology (OMERACT) Filter 2.0. METHODS We systematically reviewed all TJR trials in adults, published in English in 2008 or 2013. Searches were conducted in the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. Two authors independently applied the inclusion criteria for the studies, and any disagreement was resolved with a third review author. All outcome measures were abstracted using a pre-piloted standardised data extraction form and assessed for whether they mapped to one of the three OMERACT Filter 2.0 core areas: pathophysiological, life impact, and death. RESULTS From 1635 trials identified, we included 70 trials (30 in 2008 and 40 in 2013) meeting the eligibility criteria. Twenty-two (31%) trials reported the three essential OMERACT core areas. Among the 27 hip replacement surgery trials and 39 knee replacement surgery trials included, 11 hip (41%) and nine knee (23%) trials reported all three essential OMERACT core areas. The most common outcome domains/measures were pain (20/27, 74%) and function (23/27, 85%) in hip trials and pain (26/39, 67%) and function (27/39, 69%) in knee trials. Results were similar for shoulder and hand joint replacement trials. CONCLUSIONS We identified significant gaps in the measurement of OMERACT core outcome areas in TJR trials, despite the majority reporting outcome domains of pain and function. An international consensus of key stakeholders is needed to develop a core domain set for reporting of TJR trials. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014009216.
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Affiliation(s)
- Peter D H Wall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Bethan L Richards
- Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Andrew Sprowson
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Frankston, VIC, Australia.,Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, VIC, Australia
| | - Jasvinder A Singh
- Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA. .,Mayo Clinic School of Medicine, Rochester, MN, USA.
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Richards BL, Wall PDH, Sprowson AP, Singh JA, Buchbinder R. Outcome Measures Used in Arthroplasty Trials: Systematic Review of the 2008 and 2013 Literature. J Rheumatol 2017; 44:1277-1287. [PMID: 28507180 DOI: 10.3899/jrheum.161477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Previously published literature assessing the reporting of outcome measures used in joint replacement randomized controlled trials (RCT) has revealed disappointing results. It remains unknown whether international initiatives have led to any improvement in the quality of reporting and/or a reduction in the heterogeneity of outcome measures used. Our objective was to systematically assess and compare primary outcome measures and the risk of bias in joint replacement RCT published in 2008 and 2013. METHODS We searched MEDLINE, EMBASE, and CENTRAL for RCT investigating adult patients undergoing joint replacement surgery. Two authors independently identified eligible trials, extracted data, and assessed risk of bias using the Cochrane tool. RESULTS Seventy RCT (30 in 2008, 40 in 2013) met the eligibility criteria. There was no significant difference in the number of trials judged to be at low overall risk of bias (n = 6, 20%) in 2008 compared with 2013 [6 (15%); chi-square = 0.302, p = 0.75]. Significantly more trials published in 2008 did not specify a primary outcome measure (n = 25, 83%) compared with 18 trials (45%) in 2013 (chi-square = 10.6316, p = 0.001). When specified, there was significant heterogeneity in the measures used to assess primary outcomes. CONCLUSION While less than a quarter of trials published in both 2008 and 2013 were judged to be at low overall risk of bias, significantly more trials published in 2013 specified a primary outcome. Although this might represent a temporal trend toward improvement, the overall frequency of primary outcome reporting and the wide heterogeneity in primary outcomes reported remain suboptimal.
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Affiliation(s)
- Bethan L Richards
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015
| | - Peter D H Wall
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015
| | - Andrew P Sprowson
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015
| | - Jasvinder A Singh
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA. .,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015.
| | - Rachelle Buchbinder
- From the Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney, Sydney; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia; Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick, Coventry, UK; Medical Center and University of Alabama at Birmingham, Birmingham, Alabama; Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,B.L. Richards, FRACP, MClinEpi, MSportsMed, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, and Sydney Medical School, University of Sydney; P.D. Wall, MBChB (Hons), MRCS (Edin), PhD, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; A.P. Sprowson, MD, FRCS, Birmingham Veterans Affairs Warwick Orthopaedics, University of Warwick; J.A. Singh, MD, MPH, Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine; R. Buchbinder, MBBS (Hons), PhD, Dept. of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash Dept. of Clinical Epidemiology, Cabrini Hospital. Dr. Sprowson died on March 13, 2015
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Ng VY, DeClaire JH, Berend KR, Gulick BC, Lombardi AV. Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res 2012; 470:99-107. [PMID: 21809150 PMCID: PMC3237987 DOI: 10.1007/s11999-011-1996-6] [Citation(s) in RCA: 224] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Coronal malalignment occurs frequently in TKA and may affect implant durability and knee function. Designed to improve alignment accuracy and precision, the patient-specific positioning guide is predicated on restoration of the overall mechanical axis and is a multifaceted new tool in achieving traditional goals of TKA. QUESTIONS/PURPOSES We compared the effectiveness of patient-specific positioning guides to manual instrumentation with intramedullary femoral and extramedullary tibial guides in restoring the mechanical axis of the extremity and achieving neutral coronal alignment of the femoral and tibial components. METHODS We retrospectively reviewed 569 TKAs performed with patient-specific positioning guides and 155 with manual instrumentation by two surgeons using postoperative long-leg radiographs. For all patients, we assessed the zone in which the overall mechanical axis passed through the knee, and for one surgeon's cases (105 patient-specific positioning guide, 55 manual instrumentation), we also measured the hip-knee-ankle angle and the individual component angles with respect to their mechanical axes. RESULTS The overall mechanical axis passed through the central third of the knee more often with patient-specific positioning guides (88%) than with manual instrumentation (78%). The overall mean hip-knee-ankle angle for patient-specific positioning guides (180.6°) was similar to manual instrumentation (181.1°), but there were fewer ± 3° hip-knee-ankle angle outliers with patient-specific positioning guides (9%) than with manual instrumentation (22%). The overall mean tibial (89.9° versus 90.4°) and femoral (90.7° versus 91.3°) component angles were closer to neutral with patient-specific positioning guides than with manual instrumentation, but the rate of ± 2° outliers was similar for both the tibia (10% versus 7%) and femur (22% versus 18%). CONCLUSIONS Patient-specific positioning guides can assist in achieving a neutral mechanical axis with reduction in outliers.
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Affiliation(s)
- Vincent Y. Ng
- Department of Orthopaedics, The Ohio State University Medical Center, Columbus, OH USA
| | | | - Keith R. Berend
- Department of Orthopaedics, The Ohio State University Medical Center, Columbus, OH USA ,Joint Implant Surgeons, Inc, 7277 Smith’s Mill Road, Suite 200, New Albany, OH 43054 USA ,Mount Carmel Health System, New Albany, OH USA
| | - Bethany C. Gulick
- Joint Implant Surgeons, Inc, 7277 Smith’s Mill Road, Suite 200, New Albany, OH 43054 USA
| | - Adolph V. Lombardi
- Joint Implant Surgeons, Inc, 7277 Smith’s Mill Road, Suite 200, New Albany, OH 43054 USA ,Mount Carmel Health System, New Albany, OH USA ,Department of Orthopaedics and Department of Biomedical Engineering, The Ohio State University Medical Center, Columbus, OH USA
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