DeFrance Michael J, Yayac Michael F, Courtney P Maxwell, Squire Matthew W
Rowan University School of Osteopathic Medicine, Stratford, NJ.
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
J Arthroplasty. 2021 Apr;36(4):1462-1469. doi: 10.1016/j.arth.2020.10.033. Epub 2020 Oct 26.
Recent studies have suggested clinical superiority with robotic-assisted arthroplasty compared to traditional techniques. However, concerns exist regarding the author's financial conflicts of interest (COI), which may influence research outcomes. This study aimed to determine whether COI relating to robotic-assisted arthroplasty influences the results of published outcomes following total hip (THA), total knee (TKA), and unicompartmental knee arthroplasty (UKA).
We performed a systematic review to identify all studies evaluating the use of robotics in THA, TKA, and UKA. An author's financial COI was identified if they reported a relevant disclosure through the American Academy of Orthopedic Surgeons or within the study article. We then queried the Open Payments website to record all payments made from a robotic company in the year prior to publication. Each study was categorized as either favoring robotics (n = 42), neutral (n = 10), or favoring traditional techniques (n = 2). We then compared the number of conflicted authors, journal impact factor, level of evidence, and mean annual industry payment to each author.
Of the 54 studies meeting inclusion criteria, 49 (91%) had an author financial COI. Conflicted studies were more likely to report favorable results of robotics than nonconflicted studies. When compared to studies favoring conventional techniques, those demonstrating favorable robotics outcomes had a higher number of conflicted authors and a higher mean industry payment per author. There was no difference in the level of evidence or journal impact factor.
Nearly all studies comparing robotic THA, TKA, and UKA to conventional techniques involve financially conflicted authors. Further studies without COI may provide unbiased results.
近期研究表明，与传统技术相比，机器人辅助关节置换术具有临床优势。然而，人们对作者的财务利益冲突（COI）存在担忧，这可能会影响研究结果。本研究旨在确定与机器人辅助关节置换术相关的财务利益冲突是否会影响全髋关节置换术（THA）、全膝关节置换术（TKA）和单髁膝关节置换术（UKA）后已发表结果。
我们进行了一项系统综述，以识别所有评估机器人技术在THA、TKA和UKA中应用的研究。如果作者通过美国骨科医师学会或在研究文章中报告了相关披露，则确定其存在财务利益冲突。然后，我们查询了开放支付网站，记录在发表前一年由机器人公司支付的所有款项。每项研究被分类为支持机器人技术（n = 42）、中立（n = 10）或支持传统技术（n = 2）。然后，我们比较了有利益冲突的作者数量、期刊影响因子、证据水平以及每位作者的平均年度行业支付金额。
在符合纳入标准的54项研究中，49项（91%）存在作者财务利益冲突。与无利益冲突的研究相比，有利益冲突的研究更有可能报告机器人技术的有利结果。与支持传统技术的研究相比，那些显示机器人技术有有利结果的研究有更多有利益冲突的作者，且每位作者的平均行业支付金额更高。证据水平或期刊影响因子没有差异。
几乎所有将机器人辅助THA、TKA和UKA与传统技术进行比较的研究都涉及有财务利益冲突的作者。进一步开展无利益冲突的研究可能会提供无偏倚的结果。
