Establishing Age-Specific Cost-Effective Annual Revision Rates for Unicompartmental Knee Arthroplasty: A Meta-Analysis

Harshvardhan Chawla*, Hassan M. Ghomrawi, Jelle P. van der List, Ashley A. Eggman, Hendrik A. Zuiderbaan, Andrew D. Pearle

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations

Abstract

Background Improved survivorship has contributed to the increased use of unicompartmental knee arthroplasty (UKA) as an alternative to total knee arthroplasty (TKA) for unicompartmental knee osteoarthritis. However, heterogeneity among cost-effectiveness analysis studies comparing UKA to TKA has prevented the derivation of discrete implant survivorship targets. The aim of this meta-analysis was to determine the age-stratified annual revision rate (ARR) threshold for UKA to become consistently cost-effective for unicompartmental knee osteoarthritis. Methods A systematic search was performed for cost-effectiveness analysis studies of UKA vs TKA. Selected publications were rated by evidence level and assessed for methodological quality. Target UKA survivorship values determined by sensitivity analysis were retrieved, converted to ARR, and combined by age category (<65, 65-74, and ≥75 years) to estimate age-specific cost-effectiveness thresholds. Results Four studies met all inclusion criteria. All publications were evidence level I-B, with high methodological quality. Combined data indicated median threshold cost-effective ARR of 1.471% (interquartile range [IQR], 1.415-1.833; age <65), 1.135% (IQR, 1.011-1.260; age 65-74), and 1.760% (IQR, 1.660-2.880; age ≥75). Current revision rates are already below the cost-effective threshold for patients aged ≥75, but exceed recommended values in younger patients. Conclusion The findings indicate that implant survivorship is a limiting factor toward achieving cost-effective UKA in patients aged <65. Strategies to improve UKA survivorship, such as shifting procedures to high-volume centers, may render UKA cost-effective in younger patients. This presents an opportunity for resource reallocation within health systems to achieve cost-effective utilization of UKA across a broader population segment.

Original languageEnglish (US)
Pages (from-to)326-335
Number of pages10
JournalJournal of Arthroplasty
Volume32
Issue number1
DOIs
StatePublished - Jan 1 2017

Keywords

  • annual revision rate
  • cost-effectiveness
  • healthcare policy
  • survivorship
  • unicompartmental knee arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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