#Umbrella remix 2012 free

The computer based searches combined free and MeSH search terms and keywords related to the orthopaedic procedure (for example, “total knee replacement”, “total hip replacement”, “carpal tunnel surgery”) and population (for example, “osteoarthritis”, “carpal tunnel syndrome”, “subacromial impingement syndrome”). We did separate searches for each orthopaedic procedure.

We searched Medline, Embase, and the Cochrane Library from inception to September 2020 for studies that compared the clinical effectiveness of each of the selected orthopaedic interventions with no treatment, placebo, or non-operative care. In this context, using an umbrella review of systematic reviews/meta-analyses of randomised controlled trials or other study designs in the absence of meta-analyses of randomised controlled trials, we aimed to evaluate the clinical effectiveness of the 10 most common elective orthopaedic procedures, assess whether the evidence base on these 10 orthopaedic procedures has affected guidelines, and identify gaps in the existing evidence.ĭata sources, search strategy, and study selection Whether common orthopaedic procedures for managing musculoskeletal conditions are accompanied by high quality evidence bases is unclear. 10 11 A critical appraisal of existing treatment guidelines for the management of hip and knee osteoarthritis by the Osteoarthritis Research Society International’s Treatment Guidelines Committee observed that the overall quality of existing guidelines was suboptimal and consensus recommendations were not always supported by the best available evidence. 8 Although clinical guidelines, defined as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances,” 9 aim to be informed by the best available evidence, they have often been criticised for their lack of methodological rigour and applicability. 6 7 A recent review found that 24% of all hip replacement implants available to surgeons in the UK did not have evidence for their clinical effectiveness. Concerns have been expressed that many orthopaedic surgical interventions, as well as prostheses used in these interventions, do not have readily available or high quality evidence on their clinical effectiveness to support their use. They deliver the highest level of evidence owing to their potential to minimise bias. 5 Randomised controlled trials are considered the best method to evaluate the clinical effectiveness of an intervention. The National Institute for Health and Care Excellence (NICE) defines the “clinical effectiveness of a treatment” as how beneficial the treatment is under usual or everyday conditions, compared with doing nothing or opting for another type of care. The term “clinical effectiveness” is about ensuring that healthcare practice is based on the best available data and evidence of effectiveness. 4 Although total joint replacement is considered to be a clinically effective intervention for the management of osteoarthritis, it also accounts for enormous expenditures in the health system.

Total joint replacement is one of the most common elective orthopaedic procedures performed worldwide for end stage osteoarthritis, the most common musculoskeletal condition. 3 In the UK, musculoskeletal conditions account for more than 25% of all surgical interventions in the National Health Service (NHS). 2 Although many musculoskeletal conditions can be managed in primary care through a combination of core interventions such as exercise, weight management, physical therapies, psychological therapies, and drug treatment, some patients who do not respond to conservative measures need specialist care, surgical care, or both. According to the 2017 Global Burden of Disease study, musculoskeletal conditions were the biggest contributor to global disability. Musculoskeletal conditions are typically characterised by persistent pain and restricted mobility. 1 According to the World Health Organization, the most common and disabling musculoskeletal conditions are osteoarthritis, back and neck pain, fractures associated with fragility of the bone, injuries, and systemic inflammatory conditions such as rheumatoid arthritis. About 200 musculoskeletal conditions have a substantial effect on the quality of life of millions of people in the UK and are associated with increased healthcare costs.