Understanding economic evaluations: a review of the knee arthroplasty literature

The study reviewed the literature to appraise the quality, quantity, and type of economic evaluation as it pertains to the knee arthroplasty literature. A computerized bibliographic search of MEDLINE from 1966-1996 was conducted, revealing a total of 43,178 articles dealing with cost analysis, of which 1611 were orthopedic. Of the economic orthopedic studies, only 63 dealt with the topic of knee arthroplasty. These studies were retrieved, of which only 40 papers met the inclusion criteria. These 40 studies were evaluated for methodological soundness based on established economic principles. None of the 40 studies met the established criteria to form a comprehensive economic evaluation. These results indicate that the orthopedic literature is lacking in economically sound evaluations, and guidelines are offered to aid orthopedists in appraising and improving the quality of economic studies.