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

H.D. Veldman*, R.T.A.L. de Bot, I.C. Heyligers, T.A.E.J. Boymans, M. Hiligsmann

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

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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.
Original languageEnglish
Pages (from-to)579-593
Number of pages15
JournalExpert Review of Pharmacoeconomics & Outcomes Research
Issue number4
Publication statusPublished - 4 Jul 2021


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

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