Total Joint Arthroplasty in Resource-Limited Settings: A Systematic Review and Meta-Analysis of System-Dependent Outcomes

This systematic review and meta-analysis evaluates reported outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in low- and middle-income countries (LMICs), with particular attention to variation in clinical outcomes, postoperative surveillance, and healthcare delivery characteristics. A systematic literature search of PubMed, Embase, and the Cochrane Library was conducted for studies published between January 1, 1990, and January 30, 2026. Eight observational studies met the eligibility criteria. Outcomes of interest included postoperative infection, revision surgery, dislocation, and overall complications. Random-effects meta-analyses were performed where sufficient extractable data were available, with heterogeneity assessed using I² and τ². The review aims to characterize the variability and limitations of published arthroplasty outcomes in LMIC settings, identify challenges in comparing reported complication proportions across heterogeneous institutions and follow-up periods, and propose priorities for standardized outcome reporting and longitudinal surveillance. Given the limited number of studies, differences in outcome definitions, and inconsistent follow-up, pooled estimates are interpreted descriptively rather than as definitive complication rates or evidence of causal relationships between institutional characteristics and outcomes. **Registration status:** This registration is retrospective. Study selection, data extraction, and statistical analyses were completed before registration. The registration documents the completed review and was not established prospectively.