Dorling IM, Geenen L, Heymans MJLF, Most J, Boonen B, Schotanus MGM. Cost-effectiveness of patient specific vs conventional instrumentation for total knee arthroplasty: A systematic review and meta-analysis. World J Orthop 2023; 14(6): 458-470 [PMID: 37377995 DOI: 10.5312/wjo.v14.i6.458]
Corresponding Author of This Article
Martijn G M Schotanus, BSc, MSc, PhD, Postdoc, Senior Researcher, Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, dr. H vd Hoffplein 1, Sittard-Geleen 6162 BG, Limburg, Netherlands. m.schotanus@zuyderland.nl
Research Domain of This Article
Orthopedics
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jun 18, 2023; 14(6): 458-470 Published online Jun 18, 2023. doi: 10.5312/wjo.v14.i6.458
Cost-effectiveness of patient specific vs conventional instrumentation for total knee arthroplasty: A systematic review and meta-analysis
Isobel M Dorling, Lars Geenen, Marion J L F Heymans, Jasper Most, Bert Boonen, Martijn G M Schotanus
Isobel M Dorling, Lars Geenen, Marion J L F Heymans, Jasper Most, Bert Boonen, Martijn G M Schotanus, Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen 6162 BG, Limburg, Netherlands
Marion J L F Heymans, Zuyderland Academy, Zuyderland Medical Center, Sittard-Geleen 6155 NH, Limburg, Netherlands
Jasper Most, Martijn G M Schotanus, School of Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht 6229 ER, Limburg, Netherlands
Martijn G M Schotanus, Department of Orthopaedic Surgery and Traumatology, Maastricht University Medical Center, Maastricht 6229 HX, Limburg, Netherlands
Author contributions: Dorling IM designed the research; Dorling IM and Geenen L performed the research; Heymans MJLF performed the systematic search; Dorling IM and Geenen L performed the data analysis; Most J, Boonen B, and Schotanus MGM supervised the research and revised the manuscript; Dorling IM wrote the paper.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Martijn G M Schotanus, BSc, MSc, PhD, Postdoc, Senior Researcher, Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, dr. H vd Hoffplein 1, Sittard-Geleen 6162 BG, Limburg, Netherlands. m.schotanus@zuyderland.nl
Received: December 21, 2022 Peer-review started: December 21, 2022 First decision: April 13, 2023 Revised: April 26, 2023 Accepted: May 15, 2023 Article in press: May 15, 2023 Published online: June 18, 2023 Processing time: 179 Days and 11.2 Hours
Abstract
BACKGROUND
Over the past years, patient specific instrumentation (PSI) for total knee arthroplasty (TKA) has been implemented and routinely used. No clear answer has been given on its associated cost and cost-effectiveness when compared to conventional instrumentation (CI) for TKA.
AIM
To compare the cost and cost-effectiveness of PSI TKA compared to CI TKA.
METHODS
A literature search was performed in healthcare, economical healthcare, and medical databases (MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane Library, EconLit). It was conducted in April 2021 and again in January 2022. Relevant literature included randomised controlled trials, retrospective studies, prospective studies, observational studies, and case control studies. All studies were assessed on methodological quality. Relevant outcomes included incremental cost-effectiveness ratio, quality-adjusted life years, total costs, imaging costs, production costs, sterilization associated costs, surgery duration costs and readmission rate costs. All eligible studies were assessed for risk of bias. Meta-analysis was performed for outcomes with sufficient data.
RESULTS
Thirty-two studies were included into the systematic review. Two were included in the meta-analysis. 3994 PSI TKAs and 13267 CI TKAs were included in the sample size. The methodological quality of the included studies, based on Consensus on Health Economic Criteria-scores and risk of bias, ranged from average to good. PSI TKA costs less than CI TKA when considering mean operating room time and its associated costs and tray sterilization per patient case. PSI TKA costs more compared to CI TKA when considering imaging and production costs. Considering total costs per patient case, PSI TKA is more expensive in comparison to CI TKA. Meta-analysis comparing total costs for PSI TKA, and CI TKA showed a significant higher cost for PSI TKA.
CONCLUSION
Cost for PSI and CI TKA can differ when considering distinct aspects of their implementation. Total costs per patient case are increased for PSI TKA when compared to CI TKA.
Core Tip: Patient specific instrumentation (PSI) for total knee arthroplasty (TKA) has become a frequently used technique for performing TKA. In the past decade the use of PSI TKA has not proven superior nor inferior when compared to conventional instrumentation (CI) for TKA in terms of prosthetic alignment, prosthetic survival, and patient satisfaction. However, PSI TKA has been associated with a higher healthcare cost. In this review, we critically analysed the cost of PSI TKA compared to CI TKA, focusing on all facets of their cost.
