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Meta-analysis of individual registry results enhances international registry collaboration.
Acta Orthop. 2018 Aug; 89(4):369-373
Publication Type
Journal Article
Video-Audio Media
Elizabeth W Paxton
Maziar Mohaddes
Inari Laaksonen
Michelle Lorimer
Stephen E Graves
Henrik Malchau
Robert S Namba
John Kärrholm
Ola Rolfson
Guy Cafri
Author Affiliation
a Kaiser Permanente , San Diego , CA , USA.
Acta Orthop. 2018 Aug; 89(4):369-373
Publication Type
Journal Article
Video-Audio Media
Arthroplasty, Replacement, Hip - statistics & numerical data
Cohort Studies
Hip Prosthesis - statistics & numerical data
International Cooperation
Medical Records - statistics & numerical data
Meta-Analysis as Topic
Prosthesis Design - statistics & numerical data
Prosthesis Failure
Registries - statistics & numerical data
Tantalum - therapeutic use
United States
Background and purpose - Although common in medical research, meta-analysis has not been widely adopted in registry collaborations. A meta-analytic approach in which each registry conducts a standardized analysis on its own data followed by a meta-analysis to calculate a weighted average of the estimates allows collaboration without sharing patient-level data. The value of meta-analysis as an alternative to individual patient data analysis is illustrated in this study by comparing the risk of revision of porous tantalum cups versus other uncemented cups in primary total hip arthroplasties from Sweden, Australia, and a US registry (2003-2015). Patients and methods - For both individual patient data analysis and meta-analysis approaches a Cox proportional hazard model was fit for time to revision, comparing porous tantalum (n = 23,201) with other uncemented cups (n = 128,321). Covariates included age, sex, diagnosis, head size, and stem fixation. In the meta-analysis approach, treatment effect size (i.e., Cox model hazard ratio) was calculated within each registry and a weighted average for the individual registries' estimates was calculated. Results - Patient-level data analysis and meta-analytic approaches yielded the same results with the porous tantalum cups having a higher risk of revision than other uncemented cups (HR (95% CI) 1.6 (1.4-1.7) and HR (95% CI) 1.5 (1.4-1.7), respectively). Adding the US cohort to the meta-analysis led to greater generalizability, increased precision of the treatment effect, and similar findings (HR (95% CI) 1.6 (1.4-1.7)) with increased risk of porous tantalum cups. Interpretation - The meta-analytic technique is a viable option to address privacy, security, and data ownership concerns allowing more expansive registry collaboration, greater generalizability, and increased precision of treatment effects.
PubMed ID
29589467 View in PubMed
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