Systematic Review and Meta-Analysis

Within the paradigm of evidence-based orthopedics, systematic reviews and meta-analyses top the hierarchy of evidence. A systematic review summarizes available literature of a specific research question, and meta-analysis applies statistical methods to combine results from two or more studies. Systematic reviews are increasingly published in orthopedic surgery, many answering the same clinical questions with different conclusions. A well-performed systematic review includes a clinical question that is comprehensively searched over multiple databases by at least two reviewers. Findings from systematic reviews should include outcomes most meaningful to patients and discuss results based on clinical and statistical significance. This chapter highlights characteristics of a well-conduced systematic review and meta-analysis and offers nine tips on the best methods to design, synthesize, and appraise this research methodology.