Comparison of adverse events rates and hospital cost between customized individually made implants and standard off-the-shelf implants for total knee arthroplasty

• Type of Material: Article
• Authors: Steven Culler, Emory University; Greg M. Martin, Preferred Orthopedics of the Palm Beaches; Alyssa Swearingen, Columbia University
• Language: English
• Date: 2017-12-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2017 The Authors. Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.artd.2017.05.001
• Title of Journal or Parent Work: Arthroplasty Today
• ISSN: 2352-3441
• Volume: 3
• Issue: 4
• Start Page: 257
• End Page: 263
• Keywords: TKA; Length of stay; Adverse event rate; Customized individually made implant; Hospital cost
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Background This study compares selected hospital outcomes between patients undergoing total knee arthroplasty (TKA) using either a customized individually made (CIM) implant or a standard off-the-shelf (OTS) implant. Methods A retrospective review was conducted on 248 consecutive TKA patients treated in a single institution, by the same surgeon. Patients received either CIM (126) or OTS (122) implants. Study data were collected from patients' medical record or the hospital's administrative billing record. Standard statistical methods tested for differences in selected outcome measures between the 2 study arms. Results Compared with the OTS implant study arm, the CIM implant study arm showed significantly lower transfusion rates (2.4% vs 11.6%; P =.005); a lower adverse event rate at both discharge (CIM 3.3% vs OTS 14.1%; P =.003) and 90 days after discharge (CIM 8.1% vs OTS 18.2%; P =.023); and a smaller percentage of patients were discharged to a rehabilitation or other acute care facility (4.8% vs 16.4%; P =.003). Total average real hospital cost for the TKA hospitalization between the 2 groups were nearly identical (CIM $16,192 vs OTS $16,240; P =.913). Finally, the risk-adjusted per patient total cost of care showed a net savings of $913.87 (P =.240) per patient for the CIM-TKA group, for bundle of care including the preoperative computed tomography scan, TKA hospitalization, and discharge disposition. Conclusions Patients treated with a CIM implant had significantly lower transfusion rates, fewer adverse event rates, and were less likely to be discharged to a rehabilitation facility or another acute care facility. These outcomes were achieved without increasing costs.