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

Mohamed Mosaad Hasan*, Manrui Zhang, Matthew Beal, Hassan M.K. Ghomrawi

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


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 languageEnglish (US)
Article numbere000016
JournalBMJ Surgery, Interventions, and Health Technologies
Issue number1
StatePublished - Jan 28 2020


  • health care quality, access, and evaluation
  • health technology
  • orthopedic devices
  • robotic surgical procedures
  • technology assessment, biomedical

ASJC Scopus subject areas

  • Surgery
  • Biomedical Engineering


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