User's Guide to the Orthopaedic Literature: How to Use a Systematic Literature Review

• Investigators who perform a systematic review address a focused clinical question, conduct a thorough search of the literature, apply inclusion and exclusion criteria to each potentially eligible study, critically appraise the relevant studies, conduct sensitivity analyses, and synthesize the information to draw conclusions relevant to patient care or additional study. • A meta-analysis is a quantitative (or statistical) pooling of results across eligible studies with the aim of increasing the precision of the final estimates by increasing the sample size. • The current increase in the number of small randomized trials in orthopaedic surgery provides a strong argument in favor of meta-analysis; however, the quality of the primary studies included ultimately reflects the quality of the pooled data from a meta-analysis. The conduct and publication of systematic reviews of the orthopaedic literature, which often include statistical pooling or meta-analysis, are becoming more common. This article is the third in a series of guides evaluating the validity of the surgical literature and its application to clinical practice. It provides a set of criteria for optimally interpreting systematic literature reviews and applying their results to the care of surgical patients. Authors of traditional literature reviews provide an overview of a disease or condition or one or more aspects of its etiology, diagnosis, prognosis, or management, or they summarize an area of scientific inquiry. Typically, these authors make little or no attempt to be systematic in formulating the questions that they are addressing, in searching for relevant evidence, or in summarizing the evidence that they consider. Medical students and clinicians seeking background information nevertheless often find these reviews very useful for obtaining a comprehensive overview of a clinical condition or area of inquiry. When traditional expert reviewers make recommendations, they often disagree with one another, and their advice frequently lags behind, or …