Meta-analysis of individual registry results enhances international registry collaboration

Elizabeth W Paxton, Maziar Mohaddes, Inari Laaksonen, Michelle Lorimer, Stephen E Graves, Henrik Malchau, Robert S Namba, John Kärrholm, Ola Rolfson, Guy Cafri, Elizabeth W Paxton, Maziar Mohaddes, Inari Laaksonen, Michelle Lorimer, Stephen E Graves, Henrik Malchau, Robert S Namba, John Kärrholm, Ola Rolfson, Guy Cafri

Abstract

Background and purpose - Although common in medical research, meta-analysis has not been widely adopted in registry collaborations. A meta-analytic approach in which each registry conducts a standardized analysis on its own data followed by a meta-analysis to calculate a weighted average of the estimates allows collaboration without sharing patient-level data. The value of meta-analysis as an alternative to individual patient data analysis is illustrated in this study by comparing the risk of revision of porous tantalum cups versus other uncemented cups in primary total hip arthroplasties from Sweden, Australia, and a US registry (2003-2015). Patients and methods - For both individual patient data analysis and meta-analysis approaches a Cox proportional hazard model was fit for time to revision, comparing porous tantalum (n = 23,201) with other uncemented cups (n = 128,321). Covariates included age, sex, diagnosis, head size, and stem fixation. In the meta-analysis approach, treatment effect size (i.e., Cox model hazard ratio) was calculated within each registry and a weighted average for the individual registries' estimates was calculated. Results - Patient-level data analysis and meta-analytic approaches yielded the same results with the porous tantalum cups having a higher risk of revision than other uncemented cups (HR (95% CI) 1.6 (1.4-1.7) and HR (95% CI) 1.5 (1.4-1.7), respectively). Adding the US cohort to the meta-analysis led to greater generalizability, increased precision of the treatment effect, and similar findings (HR (95% CI) 1.6 (1.4-1.7)) with increased risk of porous tantalum cups. Interpretation - The meta-analytic technique is a viable option to address privacy, security, and data ownership concerns allowing more expansive registry collaboration, greater generalizability, and increased precision of treatment effects.

Figures

Figure 1.
Figure 1.
US cohort porous tantalum versus other uncemented cup survival. Number at risk:

References

    1. Allepuz A, Havelin L, Barber T, Sedrakyan A, Graves S, Bordini B, Hoeffel D, Cafri G, Paxton E.. Effect of femoral head size on metal-on-HXLPE hip arthroplasty outcome in a combined analysis of six national and regional registries. J Bone Joint Surg Am 2014; 96(Suppl1): 12–18.
    1. Australian Orthopaedic Association National Joint Replacement Registry Annual Report. Adelaide, SA, Australia: AOA; 2016.
    1. Banerjee S, Cafri G, Isaacs A J, Graves S, Paxton E, Marinac-Dabic D, Sedrakyan A.. A distributed health data network analysis of survival outcomes: the International Consortium of Orthopaedic Registries perspective. J Bone Joint Surg Am 2014; 96(Suppl1): 7–11.
    1. Bergh C, Fenstad A M, Furnes O, Garellick G, Havelin L I, Overgaard S, Pedersen A B, Mäkelä K T, Pulkkinen P, Mohaddes M, Kärrholm J.. Increased risk of revision in patients with non-traumatic femoral head necrosis: 11,589 cases compared to 416,217 cases with primary osteoarthritis in the NARA database, 1995-2011. Acta Orthop 2014; 85(1): 11–17.
    1. Borenstein M, Hedges L V, Higgins J P T, Rothstein H R.. Introduction to meta-analysis. Chichester: Wiley; 2009.
    1. Cafri G, Banerjee S, Sedrakyan A, Paxton L, Furnes O, Graves S, Marinac-Dabic D.. Meta-analysis of survival curve data using distributed health data networks: application to hip arthroplasty studies of the International Consortium of Orthopaedic Registries. Res Synth Methods 2015; 6: 347–56.
    1. Dale H, Fenstad A M, Hallan G, Havelin L I, Furnes O, Overgaard S, Pedersen A B, Kärrholm J, Garellick G, Pulkkinen P, Eskelinen A, Mäkelä K, Engesaeter L B.. Increasing risk of prosthetic joint infection after total hip arthroplasty: 2,778 revisions due to infection after 432,168 primary THAs in the Nordic Arthroplasty Register Association (NARA). Acta Orthop 2012; 83(5): 449–58.
    1. Glidden D V, Vittinghoff E.. Modelling clustered survival data from multicentre clinical trials. Stat Med 2004; 23(3): 369–88.
    1. Graves S E. The value of arthroplasty registry data. Acta Orthop 2010; 81(1): 8–9.
    1. Graves S, Sedrakyan A, Baste V, Gioe T J, Namba R, Martinez Cruz O, Stea S, Paxton E, Banerjee S, Isaacs A J, Robertsson O.. International comparative evaluation of knee replacement with fixed or mobile-bearing posterior-stabilized prostheses. J Bone Joint Surg Am 2014; 96(Suppl1): 59–64.
    1. Havelin L I, Fenstad A M, Salomonsson R, Mehnert F, Furnes O, Overgaard S, Pedersen A B, Herberts P, Karrholm J, Garellick G.. The Nordic Arthroplasty Register Association: a unique collaboration between 3 national hip arthroplasty registries with 280,201 THRs. Acta Orthop 2009; 80(4): 393–401.
    1. Hedges L V, Olkin I.. Statistical methods for meta-analysis. New York: Academic Press; 1985.
    1. Hedges L V, Vevea J L.. Fixed and random-effects models in meta-analysis. Psychol Methods 1998; 3(4): 486–504.
    1. Herberts P, Malchau H.. Many years of registration have improved the quality of hip arthroplasty. Lakartidningen 1999; 96(20): 2469–73, 75-6.
    1. Herberts P, Malchau H.. Long-term registration has improved the quality of hip replacement: a review of the Swedish THR Register comparing 160,000 cases. Acta Orthop Scand 2000; 71(2): 111–21.
    1. Laaksonen I, Lorimer M, Gromov K, Eskelinen A, Rolfson O, Graves S, Malchau H, Mohaddes M.. Trabecular metal acetabular components in primary total hip arthroplasty. Acta Orthop 2018; [Ahead of print]
    1. Lee E W, Wei L J, Amato D A.. Cox-type regression analysis for large number of small groups of correlated failure time observations In: Eds. Klein J P, Goel P K.. Survival analysis: state of the art. Dordrecht: Kluwer; 1992.
    1. Matharu G S, Judge A, Murray D W, Pandit H G.. Trabecular metal acetabular components reduce the risk of revision following primary total hip arthroplasty: a propensity score matched study from the National Joint Registry for England and Wales. J Arthroplasty 2018; 33(2): 447–452
    1. Namba R S, Inacio M C S, Cafri G.. Increased risk of revision for high flexion total knee replacement with thicker tibial liners. Bone Joint J 2014; 96(2): 217–23.
    1. Paxton E W, Inacio M C, Kiley M L.. The Kaiser Permanente Implant Registries: effect on patient safety, quality improvement, cost effectiveness, and research opportunities. Perm J 2012; 16(2): 36–44.
    1. Paxton E W, Kiley M L, Love R, Barber T C, Funahashi T T, Inacio M C.. Kaiser Permanente implant registries benefit patient safety, quality improvement, cost-effectiveness. Jt Comm J Qual Patient Saf 2013; 39(6): 246–52.
    1. Paxton E, Cafri G, Havelin L, Stea S, Pallisó F, Graves S, Hoeffel D, Sedrakyan A.. Risk of revision following total hip arthroplasty: metal-on-conventional polyethylene compared with metal-on-highly cross-linked polyethylene bearing surfaces: international results from six registries. J Bone Joint Surg Am 2014; 96(Suppl 1): 19–24.
    1. Sedrakyan A, Paxton E, Graves S, Love R, Marinac-Dabic D.. National and international postmarket research and surveillance implementation: achievements of the International Consortium of Orthopaedic Registries initiative. J Bone Joint Surg Am 2014; 96(Suppl 1): 1–6.
    1. Sjölander A, Lichtenstein P, Larsson H, Pawitan Y.. Between-within models for survival analysis. Stat Med 2013; 32(18): 3067–76.
    1. Soderman P, Malchau H, Herberts P, Johnell O.. Are the findings in the Swedish National Total Hip Arthroplasty Register valid? A comparison between the Swedish National Total Hip Arthroplasty Register, the National Discharge Register, and the National Death Register. J Arthroplasty 2000; 15(7): 884–9.
    1. Wangen H, Havelin L I, Fenstad A M, Hallan G, Furnes O, Pedersen A B, Overgaard S, Karrholm J, Garellick G, Makela K, Eskelinen A, Nordsletten L.. Reverse hybrid total hip arthroplasty. Acta Orthop 2017; 88(3): 248–54.

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