Cost-effectiveness analyses comparing cemented, cementless, hybrid and reverse hybrid fixation in total hip arthroplasty: a systematic overview and critical appraisal of the current evidence

ABSTRACT

Background: This study aims to present an overview and critical appraisal of all previous studies comparing costs and outcomes of the different modes of fixation in total hip arthroplasty (THA). A secondary aim is to provide conclusions regarding the most cost-effective mode of implant fixation per gender and age-specific population in THA, based on high quality studies.

Methods: A systematic search was conducted to identify cost-effectiveness analyses (CEAs) comparing different modes of implant fixation in THA. Analysis of results was done with solely CEAs that had a high methodological quality.

Results: A total of 12 relevant studies were identified and presented, of which 5 were considered to have the methodological rigor for inclusion in the analysis of results. These studies found that either cemented or hybrid fixation was the most cost-effective implant fixation mode for most age- and gender-specific subgroups.

Conclusion: Currently available well performed CEAs generally support the use of cemented and hybrid fixation for all age-groups relevant for THA and both genders. However, these findings were mainly based on a single database and depended on assumptions made in the studies’ methodology. Issues discussed in this paper have to be considered and future work is needed.

KEYWORDS:

• total hip arthroplasty
• implant fixation
• cost-effectiveness
• cemented
• cementless
• hybrid
• reverse hybrid

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Supplemental material

Supplemental data for this article can be accessed here.

Author contributions

H.D. Veldman: study idea, study design, literature search, literature selection, data extraction, quality assessment, interpretation and reflection, writing the manuscript

R.T.A.L. de Bot: study design, literature search, literature selection, data extraction, quality assessment, interpretation and reflection, reviewing the manuscript

I.C. Heyligers: study design, interpretation and reflection, reviewing the manuscript

T.A.E.J. Boymans: study design, interpretation and reflection, reviewing the manuscript

M. Hiligsmann: study design, literature selection, quality assessment, interpretation and reflection, reviewing the manuscript

Additional information

Funding

This paper was not funded.