An Assessment of Quality in Hip and Knee Arthroplasty Randomized Controlled Trials: A Systematic Review.

In 30 seconds

This systematic review assessed methodological quality and reporting practices in hip and knee arthroplasty randomized controlled trials published from 2014 through 2023 in four leading orthopaedic journals. Among 566 trials, 47.5% were rated high quality, 39.8% moderate, and 12.7% low on a modified Jadad scale; lack of double blinding was a major contributor to lower ratings. Trial registration was unreported in 41.2% of articles, and 27.4% of trials with a power analysis did not recruit enough patients to meet its stated power requirement.

Key findings

• Of 566 trials, 47.5% were high quality, 39.8% moderate quality, and 12.7% low quality; lack of double blinding contributed substantially to lower ratings.
• Low or moderate quality was more common with reported industry funding (relative risk, 1.27; 95% confidence interval, 1.08 to 1.49; P = 0.006) and surgical technology focus (relative risk, 1.65; 95% confidence interval, 1.42 to 1.90; P < 0.001).
• Trial registration was unreported in 41.2% of articles, funding statements in 22.3%, and a priori power analyses were absent in 16.3% of trials.
• Among 474 trials with a power analysis, 130 (27.4%) fell short of its required sample; 77 (59.2%) of those reported no statistically significant between-group difference.

Why it matters

Trial quality and transparent reporting affect how confidently clinicians can interpret evidence on arthroplasty interventions. The review identifies recurring gaps in blinding, registration, and statistical power that may limit the credibility or interpretability of findings. These results also highlight the importance of considering methodological features, not just reported outcomes, when evaluating trial evidence.

What to keep in mind

The review was limited to trials published from 2014 through 2023 in four leading orthopaedic journals and assessed quality using a modified Jadad scale.