No differences in cost-effectiveness and short-term functional outcomes between cemented and uncemented total knee arthroplasty

Abstract

Background: There is an ongoing debate regarding optimal fixation of total knee arthroplasty (TKA), however cost has not been addressed as profoundly. Therefore, the current study primarily aimed to compare costs and costeffectiveness 1 year after cemented or uncemented TKA. A secondary objective was to compare short-term functional outcomes between both groups. Methods: A posthoc prospective observational multicenter cohort study of 60 cemented and 50 uncemented Low Contact Stress (LCS) knee systems. Outcome was evaluated using the EuroQol5D-3 L (EQ5D) index, in order to calculate quality adjusted life years (QALYs). Total costs were calculated considering direct costs within the hospital setting (inpatient cost) as well as direct and indirect costs outside the hospital. Cost-effectiveness (total costs per QALY), Oxford Knee Score (OKS) and Numeric Rating Scale (NRS) were compared between cemented and uncemented cases at 1 year after surgery. HealthBASKET project, a micro-costing approach, represents the Dutch costs and situation and was used to calculate hospital stay. (In) direct costs outside the healthcare (medical cost and productivity cost) were determined using two validated questionnaires. Results: Median costs per QALY were similar between cemented and uncemented TKA patients (€16,269 and €17, 727 respectively; p = 0.50). Median OKS (44 and 42; p = 0.79), EQ5D (0.88 and 0.90; p = 0.82) and NRS for pain (1.0 and 1.0; p = 0.48) and satisfaction (9.0 and 9.0; p = 0.15) were also comparable between both groups. Conclusion: For this type of knee implant (LCS), inpatient hospital costs and costs after hospitalization were comparable between groups.

A matched comparison of the patient-reported outcome measures of cemented and cementless total knee replacements, based on the National Joint Registry of England, Wales, Northern Ireland, and Isle of Man and England’s National PROM collection programme

“…The 6-month EQ-5D was statistically significantly higher in all age groups for cemented TKRs except in the over-75 group. This is in contrast to work by Rassir et al ( 28 ) who found no statistically significant difference in the EQ-5D or cost-effectiveness between cemented and cementless TKRs in a small study. The absolute difference in EQ-5D of 0.02 observed in our study is small, and is lower than 0.03 which is the lower end of the MCID for the EQ-5D index described by Coretti et al ( 29 ) for musculoskeletal related issues.…”

“…Prasad et al ( 27 ) more recently performed a meta-analysis comparing the midterm outcomes of cemented and cementless TKRs and also found no differences in the Western Ontario and McMaster Universities Osteoarthritis Index or Knee Society Score between groups. Additionally, Rassir et al ( 28 ) in a multicentre study found that the cemented and cementless TKRs did not differ statistically significantly in functional outcomes.…”

“…This is the largest study to date comparing the PROMs of cemented and cementless TKRs. The most important find- 20) 391 ( 18) 723 (34) 589 (28) ing was that, after matching, the cemented TKR had statistically significantly higher mean OKS, although the absolute difference was small and below the MCID for the OKS. However, a greater proportion of excellent OKS (32% vs. 28%) and lower proportion of poor OKS (19% vs. 22%) were achieved by cemented fixation.…”

“…The OKS has 12 items relating to knee pain and function, each scoring from 0 to 4, presented as an overall score on an ordinal scale between 0 and 48 (13). The mean scores are given together with the proportion attaining excellent (≥ 41 points on the OKS), good (34-41), fair (27)(28)(29)(30)(31)(32)(33), and poor (< 27) results defined by Kalairajah et al (16). The minimal clinically important difference (MCID) for the OKS has not been definitively quantified: it is thought to be between 3 and 5 points (13).…”

Incidental findings detected on preoperative CT imaging obtained for robotic-assisted joint replacements: clinical importance and the effect on the scheduled arthroplasty

“…Additionally, 90-day readmissions following TJA create an enormous national healthcare economic burden, with approximately half of the annual expenses attributed to readmissions unrelated to the TJA [11,12]. However, improvements in technique and implant positioning may mitigate the costs of revisions [13][14][15][16][17], which are responsible for the greatest readmission, post-acute care, and long-term expenses [12]. With the incidence of revision arthroplasties projected to increase over the next several decades [18,19], there is an impetus to continue optimizing techniques and technologies to reduce revision and readmission rates following primary TJA.…”