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stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng157er15-lrg.png" alt="Cover of Evidence review for hemiarthroplasty - proximal humeral fracture" /></a></div><div class="bkr_bib"><h1 id="_NBK561416_"><span itemprop="name">Evidence review for hemiarthroplasty - proximal humeral fracture</span></h1><div class="subtitle">Joint replacement (primary): hip, knee and shoulder</div><p><b>Evidence review O</b></p><p><i>NICE Guideline, No. 157</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2020 Jun</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3722-6</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2020.</div></div><div class="bkr_clear"></div></div><div id="niceng157er15.s1"><h2 id="_niceng157er15_s1_">1. Reverse total shoulder replacement versus humeral hemiarthroplasty versus conventional shoulder replacement</h2><div id="niceng157er15.s1.1"><h3>1.1. Review question: In adults having primary elective shoulder replacement for pain and functional loss after a previous proximal humeral fracture (not acute trauma), what is the clinical and cost effectiveness of reverse total shoulder arthroplasty versus humeral hemiarthroplasty versus conventional total shoulder arthroplasty?</h3></div><div id="niceng157er15.s1.2"><h3>1.2. Introduction</h3><p>The number of people having shoulder replacement surgery is increasing year on year with 6,526 detailed in the national joint registry in 2017.<a class="bibr" href="#niceng157er15.ref32" rid="niceng157er15.ref32"><sup>32</sup></a> The majority of these are elective procedures. There have been recent changes and variations in practice about which type of shoulder replacement might offer the best outcomes for different patient groups.</p><p>For people with post traumatic shoulder pathology following a proximal humeral fracture, there is no consensus on which procedure has the best outcomes amongst these patients. National Joint Registry data indicates that an increasing number of people are being treated with a reverse total shoulder replacements as opposed to a humeral hemiarthroplasty or conventional total shoulder replacement.<a class="bibr" href="#niceng157er15.ref32" rid="niceng157er15.ref32"><sup>32</sup></a> This review question was included to evaluate the published evidence on the different types of shoulder replacements in relation to patients following previous proximal humeral fractures (not acute trauma) as there is currently no consensus amongst shoulder surgeons in the UK.</p></div><div id="niceng157er15.s1.3"><h3>1.3. PICO table</h3><p>For full details see the review protocol in <a href="#niceng157er15.appa">Appendix A</a>:
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<div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng157er15tab1"><a href="/books/NBK561416/table/niceng157er15.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng157er15tab1" rid-ob="figobniceng157er15tab1"><img class="small-thumb" src="/books/NBK561416/table/niceng157er15.tab1/?report=thumb" src-large="/books/NBK561416/table/niceng157er15.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="niceng157er15.tab1"><a href="/books/NBK561416/table/niceng157er15.tab1/?report=objectonly" target="object" rid-ob="figobniceng157er15tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></p></div><div id="niceng157er15.s1.4"><h3>1.4. Clinical evidence</h3><div id="niceng157er15.s1.4.1"><h4>1.4.1. Included studies</h4><p>A search was conducted for randomised trials and observational studies comparing the effectiveness of 3 types of shoulder arthroplasty for people who have had a previous proximal humeral fracture.</p><p>No relevant clinical studies were identified.</p><p>See also the study selection flow chart in <a href="#niceng157er15.appc">Appendix C</a>:</p></div><div id="niceng157er15.s1.4.2"><h4>1.4.2. Excluded studies</h4><p>See the excluded studies list in <a href="#niceng157er15.appi">Appendix I</a>:</p></div></div><div id="niceng157er15.s1.5"><h3>1.5. Economic evidence</h3><div id="niceng157er15.s1.5.1"><h4>1.5.1. Included studies</h4><p>No relevant heath economic studies were identified.</p></div><div id="niceng157er15.s1.5.2"><h4>1.5.2. Excluded studies</h4><p>One health economic study that was relevant to this question was excluded due to assessment of limited applicability <a class="bibr" href="#niceng157er15.ref34" rid="niceng157er15.ref34"><sup>34</sup></a>. The study is listed in <a href="#niceng157er15.appi">Appendix I</a>: with reasons for exclusion given.</p><p>See also the health economic study selection flow chart in <a href="#niceng157er15.appg">Appendix G</a>:</p></div><div id="niceng157er15.s1.5.3"><h4>1.5.3. Unit costs</h4><p>Relevant unit costs are provided below to aid consideration of cost effectiveness. All three procedures map the same healthcare resource group (HRG HN52) suggesting similar resource use. However, there may be some difference in implant cost as illustrated in <a class="figpopup" href="/books/NBK561416/table/niceng157er15.tab2/?report=objectonly" target="object" rid-figpopup="figniceng157er15tab2" rid-ob="figobniceng157er15tab2">Table 2</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng157er15tab2"><a href="/books/NBK561416/table/niceng157er15.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng157er15tab2" rid-ob="figobniceng157er15tab2"><img class="small-thumb" src="/books/NBK561416/table/niceng157er15.tab2/?report=thumb" src-large="/books/NBK561416/table/niceng157er15.tab2/?report=previmg" alt="Table 2. Unit costs for different shoulder implants." /></a><div class="icnblk_cntnt"><h4 id="niceng157er15.tab2"><a href="/books/NBK561416/table/niceng157er15.tab2/?report=objectonly" target="object" rid-ob="figobniceng157er15tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Unit costs for different shoulder implants. </p></div></div></div></div><div id="niceng157er15.s1.6"><h3>1.6. Evidence statements</h3><div id="niceng157er15.s1.6.1"><h4>1.6.1. Clinical evidence statements</h4><p>No relevant published evidence was identified.</p></div><div id="niceng157er15.s1.6.2"><h4>1.6.2. Health economic evidence statements</h4><p>No relevant economic evaluations were identified.</p></div></div><div id="niceng157er15.s1.7"><h3>1.7. The committee’s discussion of the evidence</h3><div id="niceng157er15.s1.7.1"><h4>1.7.1. Interpreting the evidence</h4><div id="niceng157er15.s1.7.1.1"><h5>1.7.1.1. The outcomes that matter most</h5><p>The critical outcomes were mortality, quality of life, patient reported outcomes (PROMs), revision of joint replacement and reoperation.</p><p>The important outcomes were component failure, dislocations, return to activity or sports, deep surgical site infection, superficial surgical site infection, length of stay and major adverse events.</p><p>PROMs and quality of life are critical outcome measurements, as they are a true representation of a person’s subjective experience of joint replacement, which differentiates them from harder objective outcomes and end points such as revision surgery. It was discussed how it is easier to revise a hemiarthroplasty than a conventional total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA). Therefore, not all people in need of a TSA revision have the surgery because it is complex with more associated risks. This would be highlighted through the subjective outcomes rather than the objective outcomes. Revision is a critical outcome as it is a significant operation and the lengthier the period of time before one is in need of a revision, the better it is in terms of the initial replacement. The return to activity or sports is important, some people in need of shoulder replacement surgery are more physically active and a return to sporting activity is very important to them. Length of stay is important in terms of economics and reflects the desire of people to leave hospital earlier.</p></div><div id="niceng157er15.s1.7.1.2"><h5>1.7.1.2. The quality of the evidence</h5><p>No clinical studies were found for this review question.</p></div><div id="niceng157er15.s1.7.1.3"><h5>1.7.1.3. Benefits and harms</h5><p>No clinical studies were found for this review question. Most of the excluded studies found concentrated on acute treatment of proximal humeral fractures. NJR data would have been considered if it was adjusted for confounding factors. The committee spoke about the population for this question. Proximal humeral fractures are a fracture of top end of the arm bone where the ball of the shoulder joint breaks into 2, 3 or 4 pierces. It is left to heal and farther down the line, mostly within 12 to 18 months, the person realises the non-operative treatment has not worked. People in this situation experience a lot of pain with limited movement. The treatment options are then are either a hemiarthroplasty, which is replacing the broken and badly healed ball with a new ball, a conventional TSA, which replaces the broken ball and the shoulder socket or an RSA, which can still be done when the healed fracture is very bad and the rotator cuff tendons are torn. Hemiarthroplasty and conventional TSAs are not commonly done as the rotator cuff tendons still need to be working and in the correct place while this is not required for RSAs There is therefore an argument that a move straight to an RSA makes sense in people whose bones and rotator cuff are damaged by trauma and fractures. As long as the person’s deltoid muscle is in working order, the results of the RSA are expected to be good. This has led to a trend towards RSA over the past decade, and it is now probably the first line treatment in this population for most surgeons in the NHS. However, in people who have a lesser fracture and whose rotator cuff is still intact, a hemiarthroplasty or conventional TSA can still be considered a reasonable option because there still remains a future option to revise it to an RSA.</p><p>No clinical studies were found for this review question, and the committee could not agree on a consensus recommendation on the type of surgery for this population. So a research recommendation was made to answer the clinical question posed in this guideline.</p></div></div><div id="niceng157er15.s1.7.2"><h4>1.7.2. Cost effectiveness and resource use</h4><p>There was no published cost effectiveness studies found. The implant costs for reverse TSA and conventional TSA may be more than for hemiarthroplasty given that their prosthesis consists of 2 parts. However, implant costs are variable depending on the manufacturer. Overall procedure costs and resource use are likely to be similar, as indicated by all 3 procedures mapping to the same Health Resource Group (HRG HN52) code.</p><p>No recommendation was made due to the lack of clinical evidence. Therefore practice is likely to remain variable for this population. There are roughly 5,500 primary elective shoulder operations annually, and a small proportion of these will be people with a previous proximal humeral fracture. As current practice will not change for the small population size, and there is similarity in costs between the interventions considered, there will not be any resource impact.</p></div></div></div><div id="niceng157er15.rl.r1"><h2 id="_niceng157er15_rl_r1_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="niceng157er15.ref1">Alentorn-Geli
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CJ. Hemiarthroplasty for humeral four-part fractures for patients 65 years and older a randomized controlled trial. Clinical Orthopaedics and Related Research. 2012; 470:3483–3491 [<a href="/pmc/articles/PMC3492647/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3492647</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22895694" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22895694</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="niceng157er15.ref8">Boyer
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CM. Functional outcomes of reverse shoulder arthroplasty compared with hemiarthroplasty for acute proximal humeral fractures. Journal of Shoulder and Elbow Surgery. 2013; 22(1):32–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/22652065" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22652065</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="niceng157er15.ref10">Brorson
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A. Reverse shoulder arthroplasty in acute fractures of the proximal humerus: A systematic review. International Journal of Shoulder Surgery. 2013; 7(2):70–8 [<a href="/pmc/articles/PMC3743034/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3743034</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23960366" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23960366</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="niceng157er15.ref11">Cabarcas
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PN, Slikker
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NA, Gupta
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Z. Effectiveness and safety of interventions for treating adults with displaced proximal humeral fracture: A network meta-analysis and systematic review. PloS One. 2016; 11(11):e0166801 [<a href="/pmc/articles/PMC5115806/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5115806</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27861604" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27861604</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="niceng157er15.ref14">Cuff
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DR. Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures in elderly patients. Journal of Bone and Joint Surgery (American Volume). 2013; 95(22):2050–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/24257664" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24257664</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="niceng157er15.ref15">Cvetanovich
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GL, Chalmers
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PN, Verma
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AA. Open reduction internal fixation has fewer short-term complications than shoulder arthroplasty for proximal humeral fractures. Journal of Shoulder and Elbow Surgery. 2016; 25(4):624–631.e3 [<a href="https://pubmed.ncbi.nlm.nih.gov/26686759" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26686759</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="niceng157er15.ref16">den Hartog
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D, de Haan
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NW, Tuinebreijer
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WE. Primary shoulder arthroplasty versus conservative treatment for comminuted proximal humeral fractures: A systematic literature review. Open Orthopaedics Journal. 2010; 4:87–92 [<a href="/pmc/articles/PMC2842955/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2842955</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20309406" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20309406</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="niceng157er15.ref17">Du
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S, Ye
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J, Chen
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H, Li
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X, Lin
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Q. Interventions for Treating 3- or 4-part proximal humeral fractures in elderly patient: A network meta-analysis of randomized controlled trials. International Journal of Surgery. 2017; 48:240–246 [<a href="https://pubmed.ncbi.nlm.nih.gov/28890408" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28890408</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="niceng157er15.ref18">Farng
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E, Zingmond
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D, Krenek
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L, Soohoo
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NF. Factors predicting complication rates after primary shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2011; 20(4):557–63 [<a href="https://pubmed.ncbi.nlm.nih.gov/21324715" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21324715</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="niceng157er15.ref19">Ferrel
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JR, Trinh
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TQ, Fischer
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RA. Reverse total shoulder arthroplasty versus hemiarthroplasty for proximal humeral fractures: A systematic review. Journal of Orthopaedic Trauma. 2015; 29(1):60–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/25186842" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25186842</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="niceng157er15.ref20">Fialka
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C, Stampfl
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P, Arbes
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S, Reuter
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P, Oberleitner
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G, Vecsei
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V. Primary hemiarthroplasty in four-part fractures of the proximal humerus: Randomized trial of two different implant systems. Journal of Shoulder and Elbow Surgery. 2008; 17(2):210–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/17931895" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17931895</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="niceng157er15.ref21">Gallinet
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D, Clappaz
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P, Garbuio
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P, Tropet
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Y, Obert
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L. Three or four parts complex proximal humerus fractures: Hemiarthroplasty versus reverse prosthesis: A comparative study of 40 cases. Orthopaedics & Traumatology, Surgery & Research. 2009; 95(1):48–55 [<a href="https://pubmed.ncbi.nlm.nih.gov/19251237" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19251237</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="niceng157er15.ref22">Gallinet
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D, Ohl
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X, Decroocq
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L, Dib
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C, Valenti
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P, Boileau
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P
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et al. Is reverse total shoulder arthroplasty more effective than hemiarthroplasty for treating displaced proximal humerus fractures in older adults? A systematic review and meta-analysis. Orthopaedics & Traumatology, Surgery & Research. 2018; 104(6):759–766 [<a href="https://pubmed.ncbi.nlm.nih.gov/29969722" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29969722</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="niceng157er15.ref23">Garrigues
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GE, Johnston
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PS, Pepe
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MD, Tucker
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BS, Ramsey
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ML, Austin
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LS. Hemiarthroplasty versus reverse total shoulder arthroplasty for acute proximal humerus fractures in elderly patients. Orthopedics. 2012; 35(5):e703–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/22588413" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22588413</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="niceng157er15.ref24">Gulotta
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LV. Reverse shoulder arthroplasty provided better functional outcomes than hemiarthroplasty for acute proximal humeral fractures. Journal of Bone and Joint Surgery (American Volume). 2015; 97(10):861 [<a href="https://pubmed.ncbi.nlm.nih.gov/25995500" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25995500</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="niceng157er15.ref25">Handoll
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H, Brorson
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S. Interventions for treating proximal humeral fractures in adults. Cochrane Database of Systematic Reviews
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2015, Issue 11. Art. No.: CD000434. DOI: 10.1002/14651858.CD000434.pub4. [<a href="https://pubmed.ncbi.nlm.nih.gov/26560014" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26560014</span></a>] [<a href="http://dx.crossref.org/10.1002/14651858.CD000434.pub4" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd></dl><dl class="bkr_refwrap"><dt>26.</dt><dd><div class="bk_ref" id="niceng157er15.ref26">Holton
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J, Yousri
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T, Arealis
|
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G, Levy
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O. The role of reverse shoulder arthroplasty in management of proximal humerus fractures with fracture sequelae: A systematic review of the literature. Orthopedic Reviews. 2017; 9(1):6977 [<a href="/pmc/articles/PMC5337776/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5337776</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28286622" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28286622</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>27.</dt><dd><div class="bk_ref" id="niceng157er15.ref27">Launonen
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AP, Lepola
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V, Flinkkila
|
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T, Laitinen
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M, Paavola
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M, Malmivaara
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A. Treatment of proximal humerus fractures in the elderly: A systemic review of 409 patients. Acta Orthopaedica. 2015; 86(3):280–5 [<a href="/pmc/articles/PMC4443467/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4443467</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25574643" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25574643</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="niceng157er15.ref28">Lopiz
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Y, Garcia-Coiradas
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J, Serrano-Mateo
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L, Garcia-Fernandez
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C, Marco
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F. Reverse shoulder arthroplasty for acute proximal humeral fractures in the geriatric patient: Results, health-related quality of life and complication rates. International Orthopaedics. 2016; 40(4):771–81 [<a href="https://pubmed.ncbi.nlm.nih.gov/26780717" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26780717</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="niceng157er15.ref29">Mata-Fink
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A, Meinke
|
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M, Jones
|
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C, Kim
|
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B, Bell
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JE. Reverse shoulder arthroplasty for treatment of proximal humeral fractures in older adults: A systematic review. Journal of Shoulder and Elbow Surgery. 2013; 22(12):1737–48 [<a href="https://pubmed.ncbi.nlm.nih.gov/24246529" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24246529</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="niceng157er15.ref30">Namdari
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S, Horneff
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JG, Baldwin
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K. Comparison of hemiarthroplasty and reverse arthroplasty for treatment of proximal humeral fractures: A systematic review. Journal of Bone and Joint Surgery (American Volume). 2013; 95(18):1701–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/24048558" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24048558</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="niceng157er15.ref31">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual [updated 2018]. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.nice.org.uk<wbr style="display:inline-block"></wbr>​/article/PMG20/chapter<wbr style="display:inline-block"></wbr>​/1%20Introduction%20and%20overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="niceng157er15.ref32">National Joint Registry. 15th annual report. Hertfordshire. 2018. Available from: <a href="http://www.njrreports.org.uk/Portals/0/PDFdownloads/NJR%2015th%20Annual%20Report%202018.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.njrreports<wbr style="display:inline-block"></wbr>​.org.uk/Portals/0/PDFdownloads<wbr style="display:inline-block"></wbr>​/NJR%2015th<wbr style="display:inline-block"></wbr>​%20Annual%20Report%202018.pdf</a></div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="niceng157er15.ref33">Nijs
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S, Broos
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P. Outcome of shoulder hemiarthroplasty in acute proximal humeral fractures: A frustrating meta-analysis experience. Acta Orthopaedica Belgica. 2009; 75(4):445–51 [<a href="https://pubmed.ncbi.nlm.nih.gov/19774809" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19774809</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>34.</dt><dd><div class="bk_ref" id="niceng157er15.ref34">Osterhoff
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G, O’Hara
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NN, D’Cruz
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J, Sprague
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SA, Bansback
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N, Evaniew
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N
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et al. A cost-effectiveness analysis of reverse total shoulder arthroplasty versus hemiarthroplasty for the management of complex proximal humeral fractures in the elderly. Value in Health. 2017; 20(3):404–411 [<a href="https://pubmed.ncbi.nlm.nih.gov/28292485" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28292485</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>35.</dt><dd><div class="bk_ref" id="niceng157er15.ref35">Repetto
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I, Alessio-Mazzola
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M, Cerruti
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P, Sanguineti
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F, Formica
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M, Felli
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L. Surgical management of complex proximal humeral fractures: Pinning, locked plate and arthroplasty: Clinical results and functional outcome on retrospective series of patients. Musculoskeletal Surgery. 2017; 101(2):153–158 [<a href="https://pubmed.ncbi.nlm.nih.gov/28120283" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28120283</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>36.</dt><dd><div class="bk_ref" id="niceng157er15.ref36">Sebastia-Forcada
|
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E, Cebrian-Gomez
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R, Lizaur-Utrilla
|
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A, Gil-Guillen
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V. Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study. Journal of Shoulder and Elbow Surgery. 2014; 23(10):1419–26 [<a href="https://pubmed.ncbi.nlm.nih.gov/25086490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25086490</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="niceng157er15.ref37">Shukla
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DR, McAnany
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S, Kim
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J, Overley
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S, Parsons
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BO. Hemiarthroplasty versus reverse shoulder arthroplasty for treatment of proximal humeral fractures: A meta-analysis. Journal of Shoulder and Elbow Surgery. 2016; 25(2):330–40 [<a href="https://pubmed.ncbi.nlm.nih.gov/26644230" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26644230</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="niceng157er15.ref38">Singh
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JA, Sperling
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JW, Cofield
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RH. Ninety day mortality and its predictors after primary shoulder arthroplasty: An analysis of 4,019 patients from 1976-2008. BMC Musculoskeletal Disorders. 2011; 12:231 [<a href="/pmc/articles/PMC3206490/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3206490</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21992475" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21992475</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>39.</dt><dd><div class="bk_ref" id="niceng157er15.ref39">Spross
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C, Meester
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J, Mazzucchelli
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RA, Puskas
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GJ, Zdravkovic
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V, Jost
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B. Evidence-based algorithm to treat patients with proximal humerus fractures-a prospective study with early clinical and overall performance results. Journal of Shoulder and Elbow Surgery. 2019; 28(6):1022–1032 [<a href="https://pubmed.ncbi.nlm.nih.gov/31003888" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31003888</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="niceng157er15.ref40">Sumrein
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BO, Huttunen
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TT, Launonen
|
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AP, Berg
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HE, Fellander-Tsai
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L, Mattila
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VM. Proximal humeral fractures in Sweden-a registry-based study. Osteoporosis International. 2017; 28(3):901–907 [<a href="https://pubmed.ncbi.nlm.nih.gov/27787593" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27787593</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>41.</dt><dd><div class="bk_ref" id="niceng157er15.ref41">Wang
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J, Zhu
|
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Y, Zhang
|
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F, Chen
|
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W, Tian
|
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Y, Zhang
|
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Y. Meta-analysis suggests that reverse shoulder arthroplasty in proximal humerus fractures is a better option than hemiarthroplasty in the elderly. International Orthopaedics. 2016; 40(3):531–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/26105763" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26105763</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>42.</dt><dd><div class="bk_ref" id="niceng157er15.ref42">Young
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SW, Segal
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BS, Turner
|
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PC, Poon
|
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PC. Comparison of functional outcomes of reverse shoulder arthroplasty versus hemiarthroplasty in the primary treatment of acute proximal humerus fracture. ANZ Journal of Surgery. 2010; 80(11):789–93 [<a href="https://pubmed.ncbi.nlm.nih.gov/20969685" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20969685</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>43.</dt><dd><div class="bk_ref" id="niceng157er15.ref43">Young
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SW, Zhu
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M, Walker
|
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CG, Poon
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PC. Comparison of functional outcomes of reverse shoulder arthroplasty with those of hemiarthroplasty in the treatment of cuff-tear arthropathy: A matched-pair analysis. Journal of Bone and Joint Surgery (American Volume). 2013; 95(10):910–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/23677358" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23677358</span></a>]</div></dd></dl></dl></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng157er15.appa"><h3>Appendix A. Review protocols</h3><p id="niceng157er15.appa.et1"><a href="/books/NBK561416/bin/niceng157er15-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 3. Review protocol: shoulder arthroplasty after previous proximal humeral fracture</a><span class="small"> (PDF, 207K)</span></p><p id="niceng157er15.appa.tab1"><a href="/books/NBK561416/table/niceng157er15.appa.tab1/?report=objectonly" target="object" rid-ob="figobniceng157er15appatab1" class="figpopup">Table 4. Health economic review protocol</a></p></div><div id="niceng157er15.appb"><h3>Appendix B. Literature search strategies</h3><p>The literature searches for this review are detailed below and complied with the methodology outlined in Developing NICE guidelines: the manual.<a class="bibr" href="#niceng157er15.ref31" rid="niceng157er15.ref31"><sup>31</sup></a></p><p><i>For more detailed information, please see the</i>
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<a href="/books/NBK561416/bin/niceng157er15_bm1.pdf">Methodology Review</a>.</p><div id="niceng157er15.appb.s1"><h4>B.1. Clinical search literature search strategy</h4><p>Searches were constructed using a PICO framework where population (P) terms were combined with Intervention (I) and in some cases Comparison (C) terms. Outcomes (O) are rarely used in search strategies for interventions as these concepts may not be well described in title, abstract or indexes and therefore difficult to retrieve. Search filters were applied to the searches where appropriate.</p><p>Due to the size of retrieval, only the population was used in this search.</p><p id="niceng157er15.appb.tab1"><a href="/books/NBK561416/table/niceng157er15.appb.tab1/?report=objectonly" target="object" rid-ob="figobniceng157er15appbtab1" class="figpopup">Table 5. Database date parameters and filters used</a></p><p id="niceng157er15.appb.tab2"><a href="/books/NBK561416/table/niceng157er15.appb.tab2/?report=objectonly" target="object" rid-ob="figobniceng157er15appbtab2" class="figpopup">Medline (Ovid) search terms</a></p><p id="niceng157er15.appb.tab3"><a href="/books/NBK561416/table/niceng157er15.appb.tab3/?report=objectonly" target="object" rid-ob="figobniceng157er15appbtab3" class="figpopup">Embase (Ovid) search terms</a></p><p id="niceng157er15.appb.tab4"><a href="/books/NBK561416/table/niceng157er15.appb.tab4/?report=objectonly" target="object" rid-ob="figobniceng157er15appbtab4" class="figpopup">Cochrane Library (Wiley) search terms</a></p></div><div id="niceng157er15.appb.s2"><h4>B.2. Health Economics literature search strategy</h4><p>Health economic evidence was identified by conducting a broad search relating to the joint replacement population in NHS Economic Evaluation Database (NHS EED – this ceased to be updated after March 2015) and the Health Technology Assessment database (HTA) with no date restrictions. NHS EED and HTA databases are hosted by the Centre for Research and Dissemination (CRD). Additional health economics searches were run in Medline and Embase.</p><p id="niceng157er15.appb.tab5"><a href="/books/NBK561416/table/niceng157er15.appb.tab5/?report=objectonly" target="object" rid-ob="figobniceng157er15appbtab5" class="figpopup">Table 6. Database date parameters and filters used</a></p><p id="niceng157er15.appb.tab6"><a href="/books/NBK561416/table/niceng157er15.appb.tab6/?report=objectonly" target="object" rid-ob="figobniceng157er15appbtab6" class="figpopup">Medline (Ovid) search terms</a></p><p id="niceng157er15.appb.tab7"><a href="/books/NBK561416/table/niceng157er15.appb.tab7/?report=objectonly" target="object" rid-ob="figobniceng157er15appbtab7" class="figpopup">Embase (Ovid) search terms</a></p><p id="niceng157er15.appb.tab8"><a href="/books/NBK561416/table/niceng157er15.appb.tab8/?report=objectonly" target="object" rid-ob="figobniceng157er15appbtab8" class="figpopup">NHS EED and HTA (CRD) search terms</a></p></div></div><div id="niceng157er15.appc"><h3>Appendix C. Clinical evidence selection</h3><p id="niceng157er15.appc.fig1"><a href="/books/NBK561416/figure/niceng157er15.appc.fig1/?report=objectonly" target="object" rid-ob="figobniceng157er15appcfig1" class="figpopup">Figure 1. Flow chart of clinical study selection for the review of shoulder arthroplasty after previous proximal humeral fracture</a></p></div><div id="niceng157er15.appd"><h3>Appendix D. Clinical evidence tables</h3><p>No evidence was identified.</p></div><div id="niceng157er15.appe"><h3>Appendix E. Forest plots</h3><p>No evidence was identified.</p></div><div id="niceng157er15.appf"><h3>Appendix F. GRADE tables</h3><p>No evidence was identified</p></div><div id="niceng157er15.appg"><h3>Appendix G. Health economic evidence selection</h3><p id="niceng157er15.appg.fig1"><a href="/books/NBK561416/figure/niceng157er15.appg.fig1/?report=objectonly" target="object" rid-ob="figobniceng157er15appgfig1" class="figpopup">Figure 2. Flow chart of health economic study selection for the guideline</a></p></div><div id="niceng157er15.apph"><h3>Appendix H. Health economic evidence tables</h3><p>None</p></div><div id="niceng157er15.appi"><h3>Appendix I. Excluded studies</h3><div id="niceng157er15.appi.s1"><h4>I.1. Excluded clinical studies</h4><p id="niceng157er15.appi.tab1"><a href="/books/NBK561416/table/niceng157er15.appi.tab1/?report=objectonly" target="object" rid-ob="figobniceng157er15appitab1" class="figpopup">Table 7. Studies excluded from the clinical review</a></p></div><div id="niceng157er15.appi.s2"><h4>I.2. Excluded health economic studies</h4><p id="niceng157er15.appi.tab2"><a href="/books/NBK561416/table/niceng157er15.appi.tab2/?report=objectonly" target="object" rid-ob="figobniceng157er15appitab2" class="figpopup">Table 8. Studies excluded from the health economic review</a></p></div></div><div id="niceng157er15.appj"><h3>Appendix J. Research recommendations</h3><div id="niceng157er15.appj.s1"><h4>J.1. Procedures for shoulder replacement for people with a previous proximal humeral fracture</h4><p>
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<b>Research question: In adults having primary elective shoulder replacement for pain and functional loss after a previous proximal humeral fracture (not acute trauma), what is the clinical and cost effectiveness of reverse total shoulder replacement compared with humeral hemiarthroplasty?</b>
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</p><p>
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<b>Why this is important:</b>
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</p><p>The number of people having shoulder replacement surgery is increasing year on year with over 6,500 people having their shoulder replaced in the UK in 2017. Some of these are done for acute fractures but the vast majority are elective procedures for arthritic problems. Many acute fractures of the proximal humerus are treated non-operatively. A number of these go onto to develop post traumatic problems such as a non-union or post traumatic arthritis. For these people with post traumatic shoulder problems following a proximal humeral fracture, there is no consensus on which procedure has the best outcomes. National Joint Registry data now indicates that an increasing number of people are being treated with a reverse total shoulder replacements as opposed to a humeral hemiarthroplasty or in some circumstances a conventional total shoulder replacement. This NICE guideline was unable to find any evidence to make a recommendation on which type of shoulder replacements to use in patients pain and functional loss following previous proximal humeral fractures (not acute trauma).</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng157er15appjtab1"><a href="/books/NBK561416/table/niceng157er15.appj.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figniceng157er15appjtab1" rid-ob="figobniceng157er15appjtab1"><img class="small-thumb" src="/books/NBK561416/table/niceng157er15.appj.tab1/?report=thumb" src-large="/books/NBK561416/table/niceng157er15.appj.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="niceng157er15.appj.tab1"><a href="/books/NBK561416/table/niceng157er15.appj.tab1/?report=objectonly" target="object" rid-ob="figobniceng157er15appjtab1">Table</a></h4><p class="float-caption no_bottom_margin"><i>Population</i>: People with pain and functional loss after a previous proximal humeral fracture (not acute trauma) in need of a shoulder replacement procedure. <i>Intervention(s)</i>: Reverse Total Shoulder replacement</p></div></div></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Intervention evidence review underpinning the research recommendation in the NICE guideline</p><p>This evidence review was developed by the National Guideline Centre, hosted by the Royal College of Physicians</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and, where appropriate, their carer or guardian.</p><p>Local commissioners and providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2020.</div><div class="small"><span class="label">Bookshelf ID: NBK561416</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/32881457" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">32881457</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng157er15tab1"><div id="niceng157er15.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561416/table/niceng157er15.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er15.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng157er15.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng157er15.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People who have pain and functional loss after a previous proximal humeral fracture and are indicated for shoulder arthroplasty.</td></tr><tr><th id="hd_b_niceng157er15.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions</th><td headers="hd_b_niceng157er15.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Reverse total shoulder arthroplasty</div></li><li class="half_rhythm"><div>Conventional total shoulder arthroplasty</div></li><li class="half_rhythm"><div>Shoulder humeral hemiarthroplasty</div></li></ul></td></tr><tr><th id="hd_b_niceng157er15.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_niceng157er15.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison of interventions</td></tr><tr><th id="hd_b_niceng157er15.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng157er15.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Critical</b>
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<ul><li class="half_rhythm"><div>Mortality: life expectancy (dichotomous)</div></li><li class="half_rhythm"><div>Mortality: 30 day (dichotomous)</div></li><li class="half_rhythm"><div>Quality of life at 6 weeks or earlier, later than 6 weeks up to 1 year, at least 2 years (continuous)</div></li><li class="half_rhythm"><div>Patient Reported Outcome Measures (PROMs) at 6 weeks or earlier, later than 6 weeks up to 1 year, at least 2 years (continuous)</div></li><li class="half_rhythm"><div>Revision of joint replacement (time to event)</div></li><li class="half_rhythm"><div>Reoperation Patient Reported Outcome Measures (PROMs) at 6 weeks or earlier, later than 6 weeks up to 1 year, at least 2 years (dichotomous)</div></li></ul>
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<b>Important</b>
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<ul><li class="half_rhythm"><div>Component failure (dichotomous)</div></li><li class="half_rhythm"><div>Dislocations within 1 year, after 1 year (dichotomous)</div></li><li class="half_rhythm"><div>Return to activity/sports (time to event)</div></li><li class="half_rhythm"><div>Deep surgical site Infection (dichotomous)</div></li><li class="half_rhythm"><div>Superficial surgical site infection (dichotomous)</div></li><li class="half_rhythm"><div>Length of stay (continuous)</div></li><li class="half_rhythm"><div>Major adverse events (including nerve injury, MI, VTE)</div></li></ul></td></tr><tr><th id="hd_b_niceng157er15.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng157er15.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Randomised controlled trials</p><p>If no well-conducted RCTs are available, then observational studies with multivariate analysis will be investigated.</p></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er15tab2"><div id="niceng157er15.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Unit costs for different shoulder implants</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561416/table/niceng157er15.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er15.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng157er15.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Type of shoulder procedure</th><th id="hd_h_niceng157er15.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Implant cost (£)</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er15.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reverse total shoulder arthroplasty</td><td headers="hd_h_niceng157er15.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£2,996</td></tr><tr><td headers="hd_h_niceng157er15.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Conventional total shoulder arthroplasty</td><td headers="hd_h_niceng157er15.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£2,307</td></tr><tr><td headers="hd_h_niceng157er15.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Hemiarthroplasty</td><td headers="hd_h_niceng157er15.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">£1,013</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: Implant costs are taken from a private provider supplied by a committee member. The magnitude of difference may differ for other providers.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng157er15appatab1"><div id="niceng157er15.appa.tab1" class="table"><h3><span class="label">Table 4</span><span class="title">Health economic review protocol</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561416/table/niceng157er15.appa.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er15.appa.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng157er15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Review question</th><th id="hd_h_niceng157er15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">All questions – health economic evidence</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Objectives</b>
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</td><td headers="hd_h_niceng157er15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">To identify health economic studies relevant to any of the review questions.</td></tr><tr><td headers="hd_h_niceng157er15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Search criteria</b>
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</td><td headers="hd_h_niceng157er15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Populations, interventions and comparators must be as specified in the clinical review protocol above.</div></li><li class="half_rhythm"><div>Studies must be of a relevant health economic study design (cost–utility analysis, cost-effectiveness analysis, cost–benefit analysis, cost–consequences analysis, comparative cost analysis).</div></li><li class="half_rhythm"><div>Studies must not be a letter, editorial or commentary, or a review of health economic evaluations. (Recent reviews will be ordered although not reviewed. The bibliographies will be checked for relevant studies, which will then be ordered.)</div></li><li class="half_rhythm"><div>Unpublished reports will not be considered unless submitted as part of a call for evidence.</div></li><li class="half_rhythm"><div>Studies must be in English.</div></li></ul></td></tr><tr><td headers="hd_h_niceng157er15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Search strategy</b>
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</td><td headers="hd_h_niceng157er15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A health economic study search will be undertaken using population-specific terms and a health economic study filter – see <a href="#niceng157er15.appb">appendix B</a> below.</td></tr><tr><td headers="hd_h_niceng157er15.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Review strategy</b>
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</td><td headers="hd_h_niceng157er15.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Studies not meeting any of the search criteria above will be excluded. Studies published before 2003, abstract-only studies and studies from low or middle-income countries (e.g. most non-OECD countries) or the USA will also be excluded.</p>
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<p>Each remaining study will be assessed for applicability and methodological limitations using the NICE economic evaluation checklist which can be found in appendix H of Developing NICE guidelines: the manual (2014).<a class="bibr" href="#niceng157er15.ref31" rid="niceng157er15.ref31"><sup>31</sup></a></p>
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<p><b>Inclusion and exclusion criteria</b></p>
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<ul><li class="half_rhythm"><div>If a study is rated as both ‘Directly applicable’ and with ‘Minor limitations’ then it will be included in the guideline. A health economic evidence table will be completed and it will be included in the health economic evidence profile.</div></li><li class="half_rhythm"><div>If a study is rated as either ‘Not applicable’ or with ‘Very serious limitations’ then it will usually be excluded from the guideline. If it is excluded then a health economic evidence table will not be completed and it will not be included in the health economic evidence profile.</div></li><li class="half_rhythm"><div>If a study is rated as ‘Partially applicable’, with ‘Potentially serious limitations’ or both then there is discretion over whether it should be included.</div></li></ul>
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<p><b>Where there is discretion</b></p>
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<p>The health economist will make a decision based on the relative applicability and quality of the available evidence for that question, in discussion with the guideline committee if required. The ultimate aim is to include health economic studies that are helpful for decision-making in the context of the guideline and the current NHS setting. If several studies are considered of sufficiently high applicability and methodological quality that they could all be included, then the health economist, in discussion with the committee if required, may decide to include only the most applicable studies and to selectively exclude the remaining studies. All studies excluded on the basis of applicability or methodological limitations will be listed with explanation in the excluded health economic studies appendix below.</p>
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<p>The health economist will be guided by the following hierarchies.</p>
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<p><i>Setting:</i>
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<ul><li class="half_rhythm"><div>UK NHS (most applicable).</div></li><li class="half_rhythm"><div>OECD countries with predominantly public health insurance systems (for example, France, Germany, Sweden).</div></li><li class="half_rhythm"><div>OECD countries with predominantly private health insurance systems (for example, Switzerland).</div></li><li class="half_rhythm"><div>Studies set in non-OECD countries or in the USA will be excluded before being assessed for applicability and methodological limitations.</div></li></ul></p>
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<p><i>Health economic study type:</i>
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<ul><li class="half_rhythm"><div>Cost–utility analysis (most applicable).</div></li><li class="half_rhythm"><div>Other type of full economic evaluation (cost–benefit analysis, cost-effectiveness analysis, cost–consequences analysis).</div></li><li class="half_rhythm"><div>Comparative cost analysis.</div></li><li class="half_rhythm"><div>Non-comparative cost analyses including cost-of-illness studies will be excluded before being assessed for applicability and methodological limitations.</div></li></ul></p>
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<p><i>Year of analysis:</i>
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<ul><li class="half_rhythm"><div>The more recent the study, the more applicable it will be.</div></li><li class="half_rhythm"><div>Studies published in 2003 or later but that depend on unit costs and resource data entirely or predominantly from before 2003 will be rated as ‘Not applicable’.</div></li><li class="half_rhythm"><div>Studies published before 2003 will be excluded before being assessed for applicability and methodological limitations.</div></li></ul></p>
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<p><i>Quality and relevance of effectiveness data used in the health economic analysis:</i>
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<ul><li class="half_rhythm"><div>The more closely the clinical effectiveness data used in the health economic analysis match with the outcomes of the studies included in the clinical review the more useful the analysis will be for decision-making in the guideline.</div></li></ul></p></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er15appbtab1"><div id="niceng157er15.appb.tab1" class="table"><h3><span class="label">Table 5</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561416/table/niceng157er15.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er15.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng157er15.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Database</th><th id="hd_h_niceng157er15.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Dates searched</th><th id="hd_h_niceng157er15.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er15.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline (OVID)</td><td headers="hd_h_niceng157er15.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1946 – 01 May 2019</td><td headers="hd_h_niceng157er15.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Exclusions</p>
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<p>Randomised controlled trials</p>
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<p>Systematic review studies</p>
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<p>Observational studies</p>
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</td></tr><tr><td headers="hd_h_niceng157er15.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase (OVID)</td><td headers="hd_h_niceng157er15.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1974 – 01 May 2019</td><td headers="hd_h_niceng157er15.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Exclusions</p>
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<p>Randomised controlled trials</p>
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<p>Systematic review studies</p>
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<p>Observational studies</p>
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</td></tr><tr><td headers="hd_h_niceng157er15.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The Cochrane Library (Wiley)</td><td headers="hd_h_niceng157er15.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Cochrane Reviews to 2019</p>
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<p>Issue 5 of 12</p>
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<p>CENTRAL to 2019 Issue 5 of 12</p>
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</td><td headers="hd_h_niceng157er15.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er15appbtab2"><div id="niceng157er15.appb.tab2" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561416/table/niceng157er15.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er15.appb.tab2_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">arthroplasty, replacement, shoulder/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">shoulder prosthesis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(shoulder* adj4 (replace* or prosthe* or endoprosthe* or implant* or artificial or arthroplast* or hemiarthroplast* or reverse)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-3</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/5-12</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13 not 14</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/15-21</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 not 22</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 23 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">controlled clinical trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomi#ed.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomly.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Clinical Trials as topic.sh.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">trial.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/25-31</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-Analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Meta-Analysis as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(meta analy* or metanaly* or metaanaly* or meta regression).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((systematic* or evidence*) adj3 (review* or overview*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search strategy or search criteria or systematic search or study selection or data extraction).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search* adj4 literature).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cochrane.jw.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/33-42</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Epidemiologic studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Cohort studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cohort adj (study or studies or analys* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((follow up or observational or uncontrolled or non randomi#ed or epidemiologic*) adj (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((longitudinal or retrospective or prospective or cross sectional) and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Controlled Before-After Studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Historically Controlled Study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interrupted Time Series Analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(before adj2 after adj2 (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/45-54</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp case control study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case control*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/56-57</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55 or 58</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cross-sectional studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cross sectional and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/60-61</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55 or 62</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55 or 58 or 62</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24 and (32 or 43 or 63)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er15appbtab3"><div id="niceng157er15.appb.tab3" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561416/table/niceng157er15.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er15.appb.tab3_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">shoulder replacement/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">shoulder prosthesis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(shoulder* adj4 (replac* or prosthe* or endoprosthe* or implant* or artificial or arthroplast* or hemiarthroplast* or reverse)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-3</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/5-9</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 not 11</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/12-19</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 not 20</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 21 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">factorial*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(crossover* or cross over*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((doubl* or singl*) adj blind*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(assign* or allocat* or volunteer* or placebo*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">crossover procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">single blind procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">double blind procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/23-31</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">systematic review/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">meta-analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(meta analy* or metanaly* or metaanaly* or meta regression).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((systematic* or evidence*) adj3 (review* or overview*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search strategy or search criteria or systematic search or study selection or data extraction).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search* adj4 literature).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cochrane.jw.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/33-42</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Clinical study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">family study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">longitudinal study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">retrospective study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">prospective study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cohort analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">follow-up/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cohort*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52 and 53</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cohort adj (study or studies or analys* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((follow up or observational or uncontrolled or non randomi#ed or epidemiologic*) adj (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((longitudinal or retrospective or prospective or cross sectional) and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(before adj2 after adj2 (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/45-51,54-58</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp case control study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case control*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/60-61</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59 or 62</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cross-sectional study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cross sectional and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/64-65</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59 or 66</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59 or 62 or 66</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22 and (32 or 43 or 67)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er15appbtab4"><div id="niceng157er15.appb.tab4" class="table"><h3><span class="title">Cochrane Library (Wiley) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561416/table/niceng157er15.appb.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er15.appb.tab4_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Arthroplasty, Replacement, Shoulder] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Shoulder Prosthesis] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(shoulder* near/4 (replac* or prosthe* or endoprosthe* or implant* or artificial or arthroplast* or hemiarthroplast* or reverse)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(OR #1-#3)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er15appbtab5"><div id="niceng157er15.appb.tab5" class="table"><h3><span class="label">Table 6</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561416/table/niceng157er15.appb.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er15.appb.tab5_lrgtbl__"><table><thead><tr><th id="hd_h_niceng157er15.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Database</th><th id="hd_h_niceng157er15.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Dates searched</th><th id="hd_h_niceng157er15.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er15.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline</td><td headers="hd_h_niceng157er15.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2014 – 01 May 2019</td><td headers="hd_h_niceng157er15.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Health economics studies</p>
|
|
</td></tr><tr><td headers="hd_h_niceng157er15.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase</td><td headers="hd_h_niceng157er15.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2014 – 01 May 2019</td><td headers="hd_h_niceng157er15.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Health economics studies</p>
|
|
</td></tr><tr><td headers="hd_h_niceng157er15.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Centre for Research and Dissemination (CRD)</td><td headers="hd_h_niceng157er15.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HTA - Inception – 01 May 2019</p>
|
|
<p>NHSEED - Inception to March 2015</p>
|
|
</td><td headers="hd_h_niceng157er15.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er15appbtab6"><div id="niceng157er15.appb.tab6" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561416/table/niceng157er15.appb.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er15.appb.tab6_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">arthroplasty/ or arthroplasty, replacement/ or arthroplasty, replacement, hip/ or arthroplasty, replacement, knee/ or arthroplasty, replacement, shoulder/ or hemiarthroplasty/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">joint prosthesis/ or hip prosthesis/ or knee prosthesis/ or shoulder prosthesis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((joint* or knee* or shoulder* or hip*) adj5 (surger* or replace* or prosthe* or endoprosthe* or implant* or artificial or arthroplast* or hemiarthroplast*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-3</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/5-12</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13 not 14</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/15-21</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 not 22</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 23 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Value of life/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Costs and Cost Analysis”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Hospital/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Medical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Pharmaceutical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Fees and Charges”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Budgets/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/25-40</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24 and 41</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er15appbtab7"><div id="niceng157er15.appb.tab7" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561416/table/niceng157er15.appb.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er15.appb.tab7_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*arthroplasty/ or *replacement arthroplasty/ or *hip replacement/ or *knee replacement/ or *shoulder replacement/ or *hemiarthroplasty/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*joint prosthesis/ or *hip prosthesis/ or *knee prosthesis/ or *shoulder prosthesis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((joint* or knee* or shoulder* or hip*) adj5 (surger* or replace* or prosthe* or endoprosthe* or implant* or artificial or arthroplast* or hemiarthroplast*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-3</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/5-9</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 not 11</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/12-19</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 not 20</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 21 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">health economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp economic evaluation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp health care cost/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp fee/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">funding/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/23-35</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22 and 36</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er15appbtab8"><div id="niceng157er15.appb.tab8" class="table"><h3><span class="title">NHS EED and HTA (CRD) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561416/table/niceng157er15.appb.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er15.appb.tab8_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR arthroplasty</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR arthroplasty, replacement</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR arthroplasty, replacement, hip</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR arthroplasty, replacement, knee</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR arthroplasty, replacement, shoulder</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR hemiarthroplasty</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR joint prosthesis</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR hip prosthesis</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR knee prosthesis</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR shoulder prosthesis</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((joint* or knee* or shoulder* or hip*) adj5 (surger* or replace* or prosthe* or endoprosthe* or implant* or artificial or arthroplast* or hemiarthroplast*)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11) IN NHSEED</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11) IN HTA</td></tr></tbody></table></div></div></article><article data-type="fig" id="figobniceng157er15appcfig1"><div id="niceng157er15.appc.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Flow%20chart%20of%20clinical%20study%20selection%20for%20the%20review%20of%20shoulder%20arthroplasty%20after%20previous%20proximal%20humeral%20fracture.&p=BOOKS&id=561416_niceng157er15appcf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK561416/bin/niceng157er15appcf1.jpg" alt="Figure 1. Flow chart of clinical study selection for the review of shoulder arthroplasty after previous proximal humeral fracture." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Flow chart of clinical study selection for the review of shoulder arthroplasty after previous proximal humeral fracture</span></h3></div></article><article data-type="fig" id="figobniceng157er15appgfig1"><div id="niceng157er15.appg.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20Flow%20chart%20of%20health%20economic%20study%20selection%20for%20the%20guideline.&p=BOOKS&id=561416_niceng157er15appgf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK561416/bin/niceng157er15appgf1.jpg" alt="Figure 2. Flow chart of health economic study selection for the guideline." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">Flow chart of health economic study selection for the guideline</span></h3><div class="caption"><p>a) Non-relevant population, intervention, comparison, design or setting; non-English language</p><p>b) One study was applicable to both Q3.1 and Q3.2</p></div></div></article><article data-type="table-wrap" id="figobniceng157er15appitab1"><div id="niceng157er15.appi.tab1" class="table"><h3><span class="label">Table 7</span><span class="title">Studies excluded from the clinical review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561416/table/niceng157er15.appi.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er15.appi.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Study</th><th id="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Exclusion reason</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Alentorn-geli 2015<a class="bibr" href="#niceng157er15.ref1" rid="niceng157er15.ref1"><sup>1</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review protocol does not match this review. Included studies were checked.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anakwenze 2014<a class="bibr" href="#niceng157er15.ref2" rid="niceng157er15.ref2"><sup>2</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review protocol does not match this review. Included studies were checked.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Antuna 2002<a class="bibr" href="#niceng157er15.ref3" rid="niceng157er15.ref3"><sup>3</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study that does not account for confounding factors</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Baudi 2014<a class="bibr" href="#niceng157er15.ref4" rid="niceng157er15.ref4"><sup>4</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Boileau 2001<a class="bibr" href="#niceng157er15.ref5" rid="niceng157er15.ref5"><sup>5</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bonnevialle 2016<a class="bibr" href="#niceng157er15.ref6" rid="niceng157er15.ref6"><sup>6</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Boons 2012<a class="bibr" href="#niceng157er15.ref7" rid="niceng157er15.ref7"><sup>7</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Boyer 2017<a class="bibr" href="#niceng157er15.ref8" rid="niceng157er15.ref8"><sup>8</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study without adjustment for confounding factors</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Boyle 2013<a class="bibr" href="#niceng157er15.ref9" rid="niceng157er15.ref9"><sup>9</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Brorson 2013<a class="bibr" href="#niceng157er15.ref10" rid="niceng157er15.ref10"><sup>10</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review protocol does not match this review. Included studies were checked.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cabarcas 2018<a class="bibr" href="#niceng157er15.ref11" rid="niceng157er15.ref11"><sup>11</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect population. Included studies were checked.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Chalmers 2014<a class="bibr" href="#niceng157er15.ref12" rid="niceng157er15.ref12"><sup>12</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Chen 2016<a class="bibr" href="#niceng157er15.ref13" rid="niceng157er15.ref13"><sup>13</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review protocol does not match this review. Included studies were checked.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cuff 2013<a class="bibr" href="#niceng157er15.ref14" rid="niceng157er15.ref14"><sup>14</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study without adjustment for confounding factors</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cvetanovich 2016<a class="bibr" href="#niceng157er15.ref15" rid="niceng157er15.ref15"><sup>15</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Den hartog 2010<a class="bibr" href="#niceng157er15.ref16" rid="niceng157er15.ref16"><sup>16</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review protocol does not match this review. Included studies were checked.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Du 2017<a class="bibr" href="#niceng157er15.ref17" rid="niceng157er15.ref17"><sup>17</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review protocol does not match this review. Included studies were checked.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Farng 2011<a class="bibr" href="#niceng157er15.ref18" rid="niceng157er15.ref18"><sup>18</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ferrel 2015<a class="bibr" href="#niceng157er15.ref19" rid="niceng157er15.ref19"><sup>19</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review protocol does not match this review. Included studies were checked.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fialka 2008<a class="bibr" href="#niceng157er15.ref20" rid="niceng157er15.ref20"><sup>20</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gallinet 2009<a class="bibr" href="#niceng157er15.ref21" rid="niceng157er15.ref21"><sup>21</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review protocol does not match this review. Included studies were checked.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gallinet 2018<a class="bibr" href="#niceng157er15.ref22" rid="niceng157er15.ref22"><sup>22</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Garrigues 2012<a class="bibr" href="#niceng157er15.ref23" rid="niceng157er15.ref23"><sup>23</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gulotta 2015<a class="bibr" href="#niceng157er15.ref24" rid="niceng157er15.ref24"><sup>24</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Handoll 2015<a class="bibr" href="#niceng157er15.ref25" rid="niceng157er15.ref25"><sup>25</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review protocol does not match this review. Included studies were checked.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Holton 2017<a class="bibr" href="#niceng157er15.ref26" rid="niceng157er15.ref26"><sup>26</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review protocol does not match this review. Included studies were checked.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Launonen 2015<a class="bibr" href="#niceng157er15.ref27" rid="niceng157er15.ref27"><sup>27</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review protocol does not match this review. Included studies were checked.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lopiz 2016<a class="bibr" href="#niceng157er15.ref28" rid="niceng157er15.ref28"><sup>28</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mata-fink 2013<a class="bibr" href="#niceng157er15.ref29" rid="niceng157er15.ref29"><sup>29</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review protocol does not match this review. Included studies were checked.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Namdari 2013<a class="bibr" href="#niceng157er15.ref30" rid="niceng157er15.ref30"><sup>30</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review protocol does not match this review. Included studies were checked.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nijs 2009<a class="bibr" href="#niceng157er15.ref33" rid="niceng157er15.ref33"><sup>33</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review with incorrect population. Included studies were checked for this review.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Repetto 2017<a class="bibr" href="#niceng157er15.ref35" rid="niceng157er15.ref35"><sup>35</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sebastia-forcada 2014<a class="bibr" href="#niceng157er15.ref36" rid="niceng157er15.ref36"><sup>36</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Shukla 2016<a class="bibr" href="#niceng157er15.ref37" rid="niceng157er15.ref37"><sup>37</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review protocol does not match this review. Included studies were checked.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Singh 2011<a class="bibr" href="#niceng157er15.ref38" rid="niceng157er15.ref38"><sup>38</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Spross 2019<a class="bibr" href="#niceng157er15.ref39" rid="niceng157er15.ref39"><sup>39</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Treatment algorithm</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sumrein 2017<a class="bibr" href="#niceng157er15.ref40" rid="niceng157er15.ref40"><sup>40</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wang 2016<a class="bibr" href="#niceng157er15.ref41" rid="niceng157er15.ref41"><sup>41</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review protocol does not match this review. Included studies were checked.</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Young 2010<a class="bibr" href="#niceng157er15.ref42" rid="niceng157er15.ref42"><sup>42</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Young 2013<a class="bibr" href="#niceng157er15.ref43" rid="niceng157er15.ref43"><sup>43</sup></a></td><td headers="hd_h_niceng157er15.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er15appitab2"><div id="niceng157er15.appi.tab2" class="table"><h3><span class="label">Table 8</span><span class="title">Studies excluded from the health economic review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561416/table/niceng157er15.appi.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er15.appi.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng157er15.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reference</th><th id="hd_h_niceng157er15.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_niceng157er15.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Osterhoff 2017<a class="bibr" href="#niceng157er15.ref34" rid="niceng157er15.ref34"><sup>34</sup></a></td><td headers="hd_h_niceng157er15.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This study was assessed as not applicable as it does not cover the review population</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng157er15appjtab1"><div id="niceng157er15.appj.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561416/table/niceng157er15.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng157er15.appj.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng157er15.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PICO question</th><td headers="hd_b_niceng157er15.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p><b>Population</b>: People with pain and functional loss after a previous proximal humeral fracture (not acute trauma) in need of a shoulder replacement procedure.</p>
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<p><b>Intervention(s)</b>: Reverse Total Shoulder replacement</p>
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<p><b>Comparison:</b> Humeral Hemiarthroplasty</p>
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<p><b>Outcome(s):</b> Quality of life and Patient Reported Outcome Measures (PROMs) 2 year after surgery. Cost outcomes to enable cost-effectiveness analysis. Time to event data for revision surgery after 5 and 10 years.</p>
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</td></tr><tr><th id="hd_b_niceng157er15.appj.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng157er15.appj.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Randomised controlled trial nested in NJR for longer term follow up</td></tr><tr><th id="hd_b_niceng157er15.appj.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other details</th><td headers="hd_b_niceng157er15.appj.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Decision making around which shoulder replacement type for different problems made the top 10 research priorities of the 2015 James Lind Alliance PSP on Shoulder Surgery.</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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