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

Randomized controlled trials (RCTs) remain the gold standard for evaluating the efficacy and safety of novel interventions. This systematic review assessed the current quality of hip and knee arthroplasty RCTs using a modified Jadad scale, along with other key metrics, including trial registration and conduct of power analyses.

PubMed was queried in May 2024 to identify hip and knee arthroplasty RCTs published from 2014 through 2023 in four leading orthopaedic journals. Each RCT was scored using a modified Jadad scale, which assesses randomization, blinding, and participant withdrawal, categorizing studies into low, moderate, or high quality. Chi-square analyses were used to assess associations between article characteristics.

Of 566 RCTs, 47.5% were graded as high quality, 39.8% as moderate quality, and 12.7% as low quality according to the modified Jadad scale, largely due to a lack of double blinding. Low or moderate quality was more common in RCTs that reported industry funding (relative risk, 1.27; 95% confidence interval, 1.08 to 1.49; P = 0.006) or those focused on surgical technology (relative risk, 1.65; 95% confidence interval, 1.42 to 1.90; P < 0.001). Trial registration was not reported in 41.2% of articles, funding statements were not identified in 22.3% of RCTs, and a priori power analyses were not conducted in 16.3% of RCTs. Of the 474 RCTs that did conduct a power analysis, 130 (27.4%) did not retain enough patients to meet sufficient statistical power per their power analyses. Among these 130 studies, 77 (59.2%) did not identify any statistically significant difference between groups.

More than half of recent hip and knee arthroplasty RCTs were of low to moderate quality, with notable deficiencies in blinding, trial registration, and power analyses. Continued efforts to improve methodological rigor and transparency are essential to advance the quality and credibility of arthroplasty research.