Evidence map›Paper›PMID 29521152›Full record

ArticleActa orthopaedica2018

Are competing risks models appropriate to describe implant failure?

Adrian Sayers, Jonathan T Evans, Michael R Whitehouse, Ashley W Blom

Abstract read
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In one paragraph

Article in Acta orthopaedica, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
38citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

38 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors.

Adrian Sayersa Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital , Bristol.
Jonathan T Evansa Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital , Bristol.
Michael R Whitehousea Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital , Bristol.
Ashley W Bloma Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital , Bristol.

Funding

Medical Research Council MR/L01226X/1
6 · The paper itself

Abstract

Background and purpose - The use of competing risks models is widely advocated in the arthroplasty literature due to a perceived bias in comparison of simple Kaplan-Meier estimates. Proponents of competing risk models in the arthroplasty literature appear to be unaware of the subtle but important differences in interpretation of net and crude failure estimated by competing risk and Kaplan-Meier methods respectively. Methods - Using a simple simulation we illustrate the differences between competing risks and Kaplan-Meier methods. Results - Competing risk and Kaplan-Meier methods estimate different survival quantities, i.e., crude and net failure respectively. Estimates of crude failure estimated using competing risk methods will be less than net failure as estimated using Kaplan-Meier methods. Interpretation - Kaplan-Meier methods are appropriate for describing implant failure, whereas crude survival estimated using competing risk methods estimates the risk of surgical revision as it depends on both implant failure and mortality. Both competing risk models and Kaplan-Meier methods are useful in arthroplasty, and both provide unbiased estimates of crude and net failure in the absence of any confounding or selection respectively. Surgeons and researchers should carefully consider whether the use of competing risks is always justified. Lower estimates of failure from competing risk models may be misleading to surgeons who are attempting to select the best implants with the lowest failure rates for their patients.

Indexed as

Kaplan-Meier EstimateReoperationRisk AssessmentArthroplastyHumansProsthesis Failure

Identifiers

PMID29521152
PMCPMC6055780

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.