Cost of Revision Total Knee Replacement: A Protocol for Systematic Review and Meta-Analysis
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PROTOCOL
Cost of Revision Total Knee Replacement: A Protocol for Systematic Review and Meta‑Analysis Charles Ebuka Okafor1,2 · Son Nghiem1,2 · Christopher Vertullo2,3,4 · Joshua Byrnes1,2 Accepted: 9 November 2020 © The Author(s) 2020
Abstract Background A major limitation of total knee replacement (TKR), as with other joint replacements, is the risk of revision. Revision TKR is associated with high risk and economic burden to patients, healthcare providers, and societies. It will be worthwhile to assess the economic burden of revision TKR across countries or different study settings. This study aims to review the literature on the cost of revision TKR to assess costs across countries and studies, estimate a pooled cost estimate for homogenous data, and identify major cost components that contribute to the cost burden. Methods We will conduct a search of the MEDLINE (OvidSp), EMBASE, Web of Science, Cochrane Library, EconLit, and Google Scholar databases to identify relevant studies, and will use an optimally designed search approach to search for relevant studies. EndNote library will be used to manage the searched studies. Selection will be undertaken in two phases— screening and eligibility. Study selection, data extraction, and assessment of the risk of bias will be performed in duplicate, after which the data will be analysed narratively and a meta-analysis performed for homogenous studies, if possible. Discussion This protocol provides a proposed stepwise plan for conducting a systematic review and meta-analysis of the cost of revision TKR. Findings from this systematic review will provide information about the cost across settings and identify the major cost drivers of revision TKR, which will, in turn, stimulate efforts to minimize the cost. Systematic Review Registration PROSPERO CRD42020171988.
1 Background One major limitation of total knee replacement (TKR), as with other joint replacements, is the risk of revision. Revision TKR is the reoperation of the TKR procedure due to surgical failure of the primary TKR [1], where some or all of the original prosthesis components are removed and/or replaced, or new components added. The major causes of Electronic supplementary material The online version of this article (https://doi.org/10.1007/s41669-020-00242-7) contains supplementary material, which is available to authorized users. * Charles Ebuka Okafor [email protected] 1
Centre for Applied Health Economics, School of Medicine, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia
2
Menzies Health Institute, Gold Coast, QLD, Australia
3
Orthopaedic Surgery and Sports Medicine Centre, Gold Coast, QLD, Australia
4
Knee Research Australia, Gold Coast, QLD, Australia
revision TKR include infection, instability, aseptic loosening and pain [2]. Approximately 46% of revision cases occur in the early stage (within 2 years after the primary TKR), while 54% of revision cases occur 2 years after the primary TKR [3]. The revision rates across countries [2, 4–6
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