Summary of findings (SOF) comparing TSA and hemiarthroplasty.
| Outcomes | Illustrative Comparative Risks* (95% CI) | Relative Effect (95% CI) | Participants, n (studies) | Quality of the Evidence (GRADE) | Risk Difference (95% CI) and (NNT; 95% CI) | |
|---|---|---|---|---|---|---|
| Assumed Risk Total Shoulder Arthroplasty | Corresponding Risk Hemiarthroplasty | |||||
| Pain (VAS 0 to 100) Followup: 2 yrs | Mean pain (VAS) in the control groups: 6.1 points | Mean pain (VAS) in intervention groups: 7.8 higher (5.33 lower to 20.93 higher) | NA | 41 (1 study) | Low1,2 | NNT not estimable because CI for mean differences includes zero |
| Disability/Function (ASES 0 to 100) Followup: 2 yrs | Mean disability/function (ASES) in the control groups: 91.1 points | Mean disability/function (ASES) in intervention groups 10.1 higher (1.1 to 19 higher) | NA | 88 (2 studies) | Moderate2 | Absolute risk difference = 10.1% (CI 1.1–19); Relative risk difference = 44.6% (CI 5–83.9) NNT = 5 (CI 3–52) |
| Adverse events: total (intraoperative and postoperative) Followup: 2 yrs | 200 per 1000 | 238 per 1000 (74 to 762) | RR 1.19 (0.37–3.81) | 41 (1 study) | Moderate2 | Absolute risk difference = 4% (CI −21 to 29); Relative risk difference = 19% (CI −63% to 281%); NNT: not estimable3 |
| Revision rate Followup: 2 yrs | 0 per 1000 | 0 per 1000 (0 to 0) | RR 6.18 (0.77–49.52) | 88 (2 studies) | Moderate2 | Absolute risk difference = 11% (CI 1–22); Relative risk difference = 518% (CI −23 to 4852); NNT: NA3 |
| Serious adverse events | Not reported | Not reported | Not estimable | 0 (0) | Not reported | Not reported in any studies |
| Withdrawals due to adverse events | Not reported | Not reported | Not estimable | 0 (0) | Not reported | None of the studies provided this outcome |
↵* The basis for the assumed risk (i.e., the median control group risk across studies) is provided in footnotes. The corresponding risk (95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (95% CI). GRADE: Grading of Recommendations Assessment, Development, and Evaluation Working Group grades of evidence: High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important effect on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important effect on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
↵1 Unclear for allocation concealment and sequence generation and a high risk of other bias due to nonrecommended approach to analyses.
↵2 Study sample size was small, thus confidence in estimates is moderate at best.
↵3 Number needed to treat to harm not estimable since the risk difference includes 0% and was not significant.
NNT: number needed to treat; NA: not applicable; ASES: American Shoulder and Elbow Surgeons Shoulder Score; TSA: total shoulder arthroplasty; VAS: visual analog scale.