Can Technology Assistance be Cost Effective in TKA? A Simulation-Based Analysis of a Risk-prioritized, Practice-specific Framework

Abstract

Background Robotic, navigated, and patient-specific instrumentation (PSI) TKA procedures have been introduced to improve component placement precision and improve implant survivorship and other clinical outcomes. However, the best available evidence has shown that these technologies are ineffective in reducing revision rates in the general TKA patient population. Nonetheless, it seems

CORR Insights®: Can Technology Assistance be Cost Effective in TKA? A Simulation-based Analysis of a Risk-prioritized, Practice-specific Framework

“…I'm referring to factors such as younger age, higher BMI, and perhaps men. This is what Hickey et al [3] explored in an exciting follow-up study, published in this month's Clinical Orthopaedics and Related Research ® .…”

“…It makes less sense to worry about the cost-effectiveness of a modality that has not proven to be effective. Hickey et al [3] help us realize that TA-TKA may not help to reduce the revision rates and might prove cost effective in the usual patients who undergo TKA (older women). The study showed TA-TKA had modest yet promising effectiveness in patients with an elevated risk.…”

“…The predictions of cost-effectiveness in the study by Hickey et al [3] assume that TA-TKA achieves coronal alignment of ± 2.4° using patient-specific instrumentation, ± 1.9° using navigation, and ± 1.0° using robotic modalities. Should the use of TA-TKA be restricted to higher-volume centers, and should it be performed by surgeons with expertise in TA-TKA to replicate stringent coronal alignment targets?…”

“…Because it is expensive and requires more intraoperative time than conventional TKA, there are concerns of time and cost efficiency with the use of TA-TKA. There are also other risks, such as the uncertainty and potential harms associated with novelty itself [3,7]. Proponents of TA-TKA have suggested that with increased use and surgical experience, these technologies would reduce the risk of revision and mitigate the concerns of cost and time efficiency [11].…”

Projected Savings Associated with Lowering the Risk of Total Hip Arthroplasty Revision Due to Dislocation in Patients with Spinopelvic Pathology

“…Technology-assistance is also a plausible means of reducing revision risk in a patient population at higher risk of revision. 28 Investigators have reported that pre-surgical planning, computer navigation, and robotic-assistance can potentially lower the risk of rTHA due to dislocation among patients with SPP. Vigdorchik et al found that preoperative planning for rTHA due to recurrent instability resulted in 97% (108/111) survival-free dislocation at two years compared to 84% (93/111) for historical controls whereby 77% of the inappropriately positioned acetabular components would have been unrecognized without biplanar radiographs or stereoradiographic images to identify spinal deformity and spinal stiffness, which suggests an RRR of 75%.…”