OBJECTIVES:  Bundled payment is a per-capita, per-episode of care reimbursement system, which aims to incentivise the delivery of high-quality, coordinated care at the lowest possible cost. We systematically reviewed the literature to assess the impact and experiences of bundled payment systems in the field of orthopaedic surgery. METHODS:  A systematic search of the electronic databases, including PubMed, Web of Science and the Cochrane Library was performed. Results were grouped into specific outcomes of bundle payment systems: costs of episode of care; length of stay; readmission rates; and qualitative experiences. RESULTS: A total of 74 articles were retrieved with our search of which 19 studies were included in our analysis. The following outcomes were extracted: (1) The total episode of care costs of primary total joint arthoplasty (TJA) (both knee and hip) was reduced following introduction of bundled payment systems, but there was no significant difference for those undergoing revision surgery. (2) Average length of stay decreased significantly for primary and revision TJA in bundled payment systems. (3) There was a small and non-immediate decrease in the readmission rate after TJA under a bundled payment system, but there was no significant difference for those undergoing revision TJA. (4) Qualitative survey analysis suggests bundled payment strategies are perceived positively by doctors, and may be sufficient to alter physician behaviour, but concerns included disincentives to operate on high-risk patients and uncertainty about revenue sharing. CONCLUSIONS: Bundled payments appear to be effective in reducing costs, length of stay and readmission rates for primary joint arthoplasty. This systematic review is limited by the paucity of studies in the literature and the restriction of all current studies to the US healthcare system. This study warrants more thorough analysis on the specific outcomes of bundled payment systems across multiple geographies and for different procedure types.