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Meta-analyses in orthopaedic surgery


Clinical bottom line

There are more meta-analyses in orthopaedic surgery than one might think. Many have methodological limitations, and those of lower quality tended to report more positive findings. But here is an excellent place to start looking for evidence related to orthopaedic surgery.


M Bhandari et al. Meta-analyses in orthopaedic surgery. Journal of Bone & Joint Surgery 2001 83-A: 15-24.


This study sought meta-analyses in orthopaedic surgery by searching electronic databases, the Cochrane Library, reference lists, hand searching journals and proceedings of specialist meetings. Each eligible meta-analysis was reviewed and scored using the Oxman and Guyatt index, that allows a score of 1 (poor) to 7 (excellent) to be assigned using a formal method.


There were 40 meta-analyses published since the mid 1980s, and increasing since the early 19902 (Figure 1). None were published before 1984. One journal (Spine) had published more than three meta-analyses.

Figure 1: Meta-analyses published in orthopaedic surgery

The quality of the meta-analyses was evenly spread along the Oxman and Guyatt score between 1 and 7 points. Meta-analyses with negative or uncertain conclusions were more likely to have avoided bias in the selection of primary studies and to have appropriately combined their results.


The good news is that there is a body of meta-analysis in orthopaedic surgery. The bad news is that not all are up to scratch. The even better news for young surgeons in training is that there is terrific scope for doing some systematic review work and becoming an expert in a topic far earlier than is usually the case. Many brownie points to be earned here.