Introduction

Use of total hip arthroplasty (THA) and total knee arthroplasty (TKA), the two most common joint replacement surgeries, has increased dramatically over the last decade, with THA and TKA use nearly doubling . Nearly 300 000 THAs and over 600 000 TKAs were performed in the US in 2009. The surgeries have proven highly effective , but are also very costly . Cost-effectiveness analysis, one of the most common and well-established methods in economic evaluation , assesses the value of an intervention strategy relative to an alternative strategy on the basis of cost and both quality and quantity of life.

In light of the increasing number of joint replacement surgeries, it is important to understand the published evidence establishing the economic value of total joint arthroplasty (TJA). There have been several previous reviews of the cost-effectiveness of TJA in the past 10 years. Two studies by Brauer and colleagues reviewed cost-effectiveness analyses in orthopaedic surgery generally, with a focus on the quality of the existing studies . A 2004 literature review and analysis by Bozic and colleagues examined economic evaluation in THA, with a similar focus on methodological quality . These reviews each found that the dearth of studies and inadequate methodological quality of existing studies limited the role of economic evaluation of TJA in guiding policy. Two other literature reviews have highlighted economic evaluation of specific approaches to TJA, such as minimal incision THA and computer-assisted navigation in TKA . Furthermore, aside from the reviews more narrowly focussed on specific surgical approaches, these recent reviews did not include studies published later than 2003. No literature review has been published summarising studies examining the cost-effectiveness of TKA in general.

We conducted a systematic review of cost-effectiveness analyses of THA and TKA in the medical literature. We sought to create a resource for decision makers by listing published cost-effectiveness ratios for these common joint replacement surgeries. Our review included papers published between 1 January 1980 and 1 February 2012. We used the recommendations of the Panel on Cost-Effectiveness in Health and Medicine as a guide for selecting high-quality papers for our review. We sought to establish whether there is consistent evidence of the economic value of TJA, and to identify gaps in the literature as well as analyses which may need to be updated.