AQUILA: assessment of quality in lower limb arthroplasty. An expert Delphi consensus for total knee and total hip arthroplasty.

Edward R Valstar,Saskia Middeldorp,Rob GHH Nelissen,Huub JL van der Heide,Bart G Pijls,Olaf M Dekkers,Henrica MJ Van der Linden-Van der Zwaag

doi:10.1186/1471-2474-12-173

Edward R Valstar, Saskia Middeldorp + Show 5 more

Open Access

https://doi.org/10.1186/1471-2474-12-173

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Abstract

BackgroundIn the light of both the importance and large numbers of case series and cohort studies (observational studies) in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. A Delphi approach was used to develop a checklist for reporting quality, methodological quality and generalizability of case series and cohorts in total hip and total knee arthroplasty with a focus on aseptic loosening.MethodsA web-based Delphi was conducted consisting of two internal rounds and three external rounds in order to achieve expert consensus on items considered relevant for reporting quality, methodological quality and generalizability.ResultsThe internal rounds were used to construct a master list. The first external round was completed by 44 experts, 35 of them completed the second external round and 33 of them completed the third external round. Consensus was reached on an 8-item reporting quality checklist, a 6-item methodological checklist and a 22-item generalizability checklist.ConclusionsChecklist for reporting quality, methodological quality and generalizability for case series and cohorts in total hip and total knee arthroplasty were successfully created through this Delphi. These checklists should improve the accuracy, completeness and quality of case series and cohorts regarding total hip and total knee arthroplasty.

Highlights

In the light of both the importance and large numbers of case series and cohort studies in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality
Case series and cohorts are important in signalling inferior prosthesis designs, those prone to aseptic loosening, which accounts for 60% of total hip arthroplasty (THA) revisions
The AQUILA initiative resulted in a checklist for reporting quality, methodological quality and generalizability for case series and cohorts of total hip and total knee arthroplasty

Summary

Introduction

In the light of both the importance and large numbers of case series and cohort studies (observational studies) in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. In addition to personal experience, they are the most common type of evidence used by orthopaedic surgeons for clinical decision making according to a survey of the participants at the 2007 Annual Meeting of the American Orthopaedic Association [1] Their rank in the hierarchy of scientific evidence is lower than evidence obtained from randomised experiments, and they often suffer from lack of a control group, incomplete data collection, selection bias and confounding by indication [2]. Despite these issues, case series and cohorts are important in signalling inferior prosthesis designs, those prone to aseptic loosening, which accounts for 60% of THA revisions. Further advantages are great detail, relatively low costs, short study completion time and a potentially high external validity due to the inclusion of a wide range of patients [2]

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