Evaluating Spin Bias in the Abstracts of Systematic Reviews and Meta-Analyses on Robotic-Assisted Total Hip Arthroplasty: A Systematic Review.

内容摘要

Interest in robotic-assisted total hip arthroplasty (RA-THA) continues to grow, despite inconsistent evidence on its effectiveness. We sought to assess for the presence of spin bias in abstracts of systematic reviews and meta-analyses (SRMAs) comparing RA-THA to conventional total hip arthroplasty (C-THA). We conducted a systematic review of studies identified in a comprehensive search of MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from each database's inception to June 23, 2025. Search terms included "robotic," "hip," "arthroplasty," "systematic review," and "meta-analysis." Inclusion criteria were (1) SRMAs evaluating outcomes of RA-THA, (2) studies comparing RA-THA to conventional techniques, and (3) publications in English. Studies were excluded if they (1) assessed RA-THA with other robotic-assisted joint arthroplasty procedure, or (2) assessed RA-THA surgery alongside other technologies. Abstracts were assessed for the 15 most severe forms of spin as defined by Yavchitz et al. Methodological quality was assessed using the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews-2) tool. Twelve SRMAs were eligible for inclusion. Eleven SRMAs (91.7%) contained at least 1 of the 15 most severe forms of spin. Type 3 spin (selective reporting of efficacy outcomes favoring the intervention) was the most common (58%), followed by type 5 (conclusion claims the beneficial effect of the experimental intervention despite high risk of bias in primary studies; 50%), and type 11 (conclusion focuses selectively on statistically significant efficacy outcome; 33.3%). No differences in study characteristics were found between SRMAs with and without the aforementioned types of spin. All SRMAs were rated as "critically low" in methodological quality, with most not reporting funding source of included studies (91.7%). This systematic review found there is a high prevalence of spin bias in abstracts of SRMAs evaluating RA-THA. The most common type of spin involved selective reporting of outcomes favoring RA-THA (type 3). Future SRMAs can minimize spin by presenting balanced reporting of efficacy, or lack thereof, in their abstracts and strengthen methodological rigor by consistently reporting study funding sources. Level IV, Systematic review of level-I to level-IV studies. Evaluating spin bias in the abstracts of systematic reviews and meta-analyses on robotic-assisted total hip arthroplasty Why was the study done? There continues to be growing interest in the use of robotics in total hip arthroplasty, despite the evidence remaining contradictory. Systematic reviews and meta-analyses (SRMAs) allow researchers to compile and synthesize evidence on a topic of interest. Importantly, spin bias may occur in the abstracts of SRMAs. Spin bias is defined as presenting the evidence more favorably than what is actually demonstrated by the data. What did the researchers do? The research team conducted a systematic review of the literature to identify existing SRMAs on robotic-assisted total hip arthroplasty (RA-THA). Reviewers assessed each study for the presence of spin bias based on the 15 most severe forms identified by Yavchitz et al. The methodological quality of eligible SRMAs was also evaluated using the AMSTAR-2 tool. What did the researchers find? Twelve SRMAs were included in the assessment of spin bias and methodological quality. Eleven of the 12 SRMAs (91.7%) contained at least one of the 15 types of spin. Type 3 spin (selective reporting of efficacy outcomes favoring the intervention) was the most common (58%), followed by type 5 (claiming a beneficial effect of the intervention despite high risk of bias in primary studies; 50%) and type 11 (focusing selectively on statistically significant efficacy outcomes; 33.3%). Methodological quality assessment found that all SRMAs were rated as “critically low.” What do the findings mean? Findings from this study indicate that nearly all SRMAs on RA-THA present their results more favorably than the underlying evidence supports. This was most commonly achieved by selectively reporting outcomes that favored RA-THA. Future SRMAs on this topic should strive for greater balance in their presentation, ensuring that both benefits and limitations are accurately represented.