An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summary of evidence

Abstract

BackgroundSystematic 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.MethodsWe 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.ResultsBased 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.ConclusionsDespite 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.

Revisiting Short-term Outcomes of Conventional and Computer-Assisted Total Knee Arthroplasty: A Population-based Study

“…In our CATKA cohort, none had a pulmonary embolism or acute myocardial infarction. Our finding that CATKAs were associated with lower odds of postoperative complications compared with conventional TKAs is further supported by a review by Hasan et al, 7 which found that CATKAs have more favorable functional, radiological, and patient safety outcomes. Greater integration of computer navigation technology in practice may have a notable impact on the overall success of TKAs, by mitigating the odds of serious complications and improving patient outcomes.…”

“…Our study corroborates a growing body of evidence that shows CATKAs are associated with lower odds of postoperative in-hospital complications, but the adoption of this technology does not reflect this. [7][8][9][10][11][12][13][31][32][33][34][35]39,40 In the current study, CATKA represented slightly less than 10% of all TKAs. In another recent study of CATKA trends, modest increases were observed from 2010 to 2017.…”

“…In a recently published overview of systematic reviews, computer-assisted total knee arthroplasties (CATKAs) were associated with more favorable functional, radiological, and patient safety outcomes. 7 CATKAs have also been associated with a reduced risk of developing pulmonary emboli and lower rates of postoperative cardiac complications and hematomas. 8 - 10 Both image-based and imageless CATKAs were found to reduce in-hospital complications and reduce transfusion risk without markedly increasing hospital length of stay and costs.…”

A Comparison of Clinical Outcomes of Robot-Assisted and Conventional Laparoscopic Surgery

“…Qualitative data were extracted and processed into tables (cholecystectomy, Table A2; colectomy, Table A3; hysterectomy, Table A4; nephrectomy, Table A5; prostatectomy, Table A6). The quantitative data that were extracted from the included reviews are listed The quality of all included systematic reviews and meta-analyses was assessed by means of the AMSTAR 2 quality assessment tool [23][24][25]. Instead of generating an overall score, AMSTAR 2 utilizes a quality rating system [23].…”

Trends in Practice Patterns of Conventional and Computer-assisted Knee Arthroplasty: An Analysis of 570,671 Knee Arthroplasties Between 2010 and 2017

“…[12][13][14] A recent review of the literature showed that computerassisted knee arthroplasty (CAKA) is associated with improved implant positioning compared with conventional KA. 15 Initially very expensive, CAKA technology has evolved significantly in the past few years, especially with the recent introduction of low-cost and the userfriendly handheld navigation systems. With such advancements, wide use of the technology is expected.…”