Adherence of hip and knee arthroplasty studies to RSA standardization guidelines. A systematic review

Abstract

Background and purpose: Guidelines for standardization of radiostereometry (RSA) of implants were published in 2005 to facilitate comparison of outcomes between various research groups. In this systematic review, we determined how well studies have adhered to these guidelines.

Methods: We carried out a literature search to identify all articles published between January 2000 and December 2011 that used RSA in the evaluation of hip or knee prosthesis migration. 2 investigators independently evaluated each of the studies for adherence to the 13 individual guideline items. Since some of the 13 points included more than 1 criterion, studies were assessed on whether each point was fully met, partially met, or not met.

Results: 153 studies that met our inclusion criteria were identified. 61 of these were published before the guidelines were introduced (2000-2005) and 92 after the guidelines were introduced (2006-2011). The methodological quality of RSA studies clearly improved from 2000 to 2011. None of the studies fully met all 13 guidelines. Nearly half (43) of the studies published after the guidelines demonstrated a high methodological quality and adhered at least partially to 10 of the 13 guidelines, whereas less than one-fifth (11) of the studies published before the guidelines had the same methodological quality. Commonly unaddressed guideline items were related to imaging methodology, determination of precision from double examinations, and also mean error of rigid-body fitting and condition number cutoff levels.

Interpretation: The guidelines have improved methodological reporting in RSA studies, but adherence to these guidelines is still relatively low. There is a need to update and clarify the guidelines for clinical hip and knee arthroplasty RSA studies.

Figure 1.

PRISMA flow chart of study selection.

Figure 2.

The annual numbers of hip and knee arthroplasty RSA studies published from 2000 to 2011 that met the inclusion criteria (bars) and the proportion of studies with high adherence (line). The RSA guidelines where published at the end of 2005.

Figure 3.

Adherence of studies published after the guidelines to each of the 13 individual guideline items. The levels of adherence are presented in green (full adherence), yellow (partial adherence), and red (no adherence). Guidelines are presented left to right from highest to lowest adherence. The guideline number is given in parentheses.