Background The current review aimed to refresh the existing evidence on clinical effectiveness of Total Knee Replacement (TKR) in various settings, using a wide follow-up window, and to examine the determinants influencing the success of TKR, so the evidence can be systematically synthesized. Methodology Studies only with pre-post study designs, measuring patient reported outcome measures (PROMs) at two time points, pre-TKR and post-TKR, were included. Commonly used PROMs, such as Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form (SF-36) were harmonized across studies from worst to best and in the range of 0-100 scale. Effect Sizes (ES) were computed using pre-post mean differences in PROMs, quantifying post-TKR changes in the OA-affected knee. Results A total of 27 studies were included in this review. During short-term follow-up (≤ 6 months), greater improvement in WOMAC components such as pain (ES = 2.0) and function (ES = 2.3) was observed as opposed to stiffness. There was an improvement in all the scales of SF-36 except general health post-TKR. Gender (female), co-morbidities and post-operative complications were associated with poor outcomes of TKR. Discussion Improvement in clinical outcomes and performance was observed after TKR, especially between 6 months and 1 year. There was less improvement in PROMs in the long term but without any deterioration within 10 years of follow-up period. Conclusion The overall findings of this review conclude the confirmation of older knowledge with fresh evidence that TKR is definitely a clinically effective and beneficial treatment for individuals with OA knee and that too in different settings. Systematic review registration The systematic review protocol was registered in INPLASY (Registration No: INPLASY202240166)

Objectives: The major objective of this review was to summarize the evidence on the core modelling specifications and procedures on the cost-effectiveness of TKR compared to non-surgical management. Another objective of this study was to synthesize evidence of TKR cost and compare it across countries using purchasing power parity (PPP).  Methodology: The electronic databases used were MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), HTAIn repository and Cost effectiveness Analysis (CEA) registry. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) was used to assess the validity of the methods and transparency in reporting the results of the included studies. The cost of TKR surgery from high income and low- or middle-income countries were extracted and converted to single USD ($) using purchasing power parities (PPP) method.  Result: 29 studies were included in this review, out of which eight studies used Markov model, five studies used regression model, one study each reported Marginal structure model and discrete simulation model and decision tree analysis to assess cost-effectiveness of TKR. For PPP, 23 studies were included in the analysis of TKR cost. The average cost of TKR surgery was lowest in developing country like India ($3457) and highest in USA ($19,645).   Conclusion: The findings of this review showed that the Markov model was most widely used in the analysis of the cost effectiveness of TKR. Our review also concluded that the cost of TKR was higher in developed countries as compared to developing countries.

Review question / Objective: Clinically, knee is the most common site of OA, followed by the hand and hip. The main research question is what are different costing methodologies used and its quality in studies related to cost effectiveness of TKR compared to non-surgical treatment procedures. Based on this review question, the following objectives are proposed: 1. To assess different methodologies, scope and quality of studies related to cost effectiveness of TKR compared to non-surgical management. 2. To synthesize evidence of TKR cost and compare the variations across different countries. Information sources: All sources with information on TKR, economic evaluations and non-surgical management namely journals, handbooks, internet sources, published conference abstracts, thesis, and electronic databases will be searched extensively.

Review question / Objective: Clinically, knee is the most common site of osteoarthritis (OA), followed by the hand and hip. The basic research question of our study: Is total knee replacement (TKR) associated with better clinical outcomes and quality of life among patients with OA knee aged 40 and above, not responding to non-surgical management, is? Based on this review question, the following objectives are proposed, 1. to refresh the evidence on clinical effectiveness of TKR and 2. to explore the determinants influencing its success. Population Patient aged >= 40 years with OA Knee of all Kellgren Lawrence grade. Intervention Total Knee Replacement (TKR) Comparator Pre-TKR Outcome Clinical effectiveness in terms of improvement in QoL.

Objectives The main objective of this review is to summarize the evidence on the core modelling specifications and methodology on the cost-effectiveness of TKR compared to non-surgical management. Another objective of this study is to synthesize evidence of TKR cost and compare it across countries using purchasing power parity (PPP). Methodology The electronic databases used for this review were MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), HTAIn repository, Cost effectiveness Analysis (CEA) registry, and Google Scholar. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) was used to assess the validity of the methods and transparency in reporting the results. The Quality of Health Economic Studies (QHES) was used to check the quality of economic evaluation models of the studies included. The cost of TKR surgery from high income and low- or middle-income countries were extracted and converted to single USD ($) using purchasing power parities (PPP) method. Result Thirty-two studies were included in this review, out of which eight studies used Markov model, five used regression model, one each reported Marginal structure model, discrete simulation model, decision tree and Osteoarthritis Policy Model (OAPol) respectively to assess the cost-effectiveness of TKR. For PPP, twenty-six studies were included in the analysis of TKR cost. The average cost of TKR surgery was the lowest in developing country—India ($3457) and highest in USA ($19568). Conclusion The findings of this review showed that the Markov model was most widely used in the analysis of the cost effectiveness of TKR. Our review also concluded that the cost of TKR was higher in the developed countries as compared to the developing countries.