scholarly journals Comparison of Time and Cost Savings Using Different Cost Methodologies for Patient-Specific Instrumentation vs Standard Referencing in Total Ankle Arthroplasty

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141988427
Author(s):  
Ian Savage-Elliott ◽  
Victor J. Wu ◽  
Isabella Wu ◽  
John Timothy Heffernan ◽  
Ramon Rodriguez
Keyword(s):  
Intraclass Correlation ◽  
Cost Savings ◽  
Patient Specific ◽  
Fixed Cost ◽  
Level Of Evidence ◽  
Tourniquet Time ◽  
Radiographic Outcomes ◽  
Patient Specific Instrumentation ◽  
Implant Size ◽  
The Cost

Background: Patient-specific 3-D printing cutting blocks (PSI) have been used instead of traditional intramedullary cutting guides. We hypothesized that PSI would lead to significantly decreased operating room (OR) time and significant cost savings to our institution with noninferior radiographic outcomes and no difference in expected vs actual implant size when compared with standard referencing (SR). Methods: Patients who had undergone total ankle replacements at our institution from 2013 through 2016 were included in the study. Associations between demographic variables and postoperative alignment in the SR vs PSI group were calculated using the Wilcoxon rank-sum test and the intraclass correlation coefficient. The cost of the operation was calculated using both an institutionally based fixed cost of OR time and using Time Driven Activity Based Cost (TDABC) accounting. A total of 43 patients were included in the study, 13 in the SR group and 30 in the PSI group. Results: Operative time (168 vs 137 minutes) and tourniquet time (123 vs 113 minutes) were significantly lower in the PSI vs the SR group. PSI predictions were accurate 100% of the time for tibial components and 83% of the time for talar components. Average costs of TAA using PSI were significantly reduced by $7597.00 when using traditional OR accounting, whereas PSI was $836.00 more expensive on average using TDABC accounting. Conclusion: Further research is needed to determine the cost-effectiveness of PSI vs SR in TAA; however, it does appear to save time intraoperatively. The long-term effect on clinical outcomes requires further study. Level of Evidence: Level III, case-control study.

scholarly journals Does Patient-specific Instrumentation Yield Better Component Position than Standard Instrumentation in Total Ankle Arthroplasty?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0004
Author(s):  
Mario Escudero ◽  
Kevin Wing ◽  
Feras Waly ◽  
Thomas Bemenderfer ◽  
W. Hodges Davis ◽  
...  
Keyword(s):  
Computer Navigation ◽  
Outcome Data ◽  
Total Ankle Arthroplasty ◽  
Patient Specific ◽  
Published Data ◽  
Time Efficiency ◽  
Ankle Arthroplasty ◽  
Radiographic Outcomes ◽  
Patient Specific Instrumentation ◽  
Standard Instrumentation

Category: Ankle Arthritis Introduction/Purpose: The unique anatomy and biomechanics of the ankle joint have made total ankle arthroplasty (TAA) challenging over the past few decades. Final implant position and successful soft tissue balancing are key components to the longevity of total ankle implants. Preoperative computer navigation, templating, and patient-specific instrumentation (PSI) have shown promising results in total ankle replacement with accurate and reproducible radiographic outcomes. Recent data has also suggested that even experienced surgeons benefit from the improved time efficiency of PSI. The purpose of this study is to determine if radiographic outcomes differ between patients undergoing TAA with PSI and those who undergo TAA with standard instrumentation (SI). Methods: The first 67 consecutive patients who underwent primary Infinity total ankle arthroplasty (TAA) at 2 North American sites between 2013 and 2015 were reviewed in a prospective observational study. All TAA’s were performed by one of four fellowship-trained foot and ankle surgeons. Demographic, radiographic, and functional outcome data was collected preoperatively, at 6-12 months postoperatively, and annually thereafter. The radiographic variables measured were the medial distal tibial angle (MDTA), talar tilt angle (TTA), lateral talar station (LTS), sagittal distal tibial articular angle (sDTAA), and the gamma angle. Acceptable intervals for each parameter were selected and TAAs were then categorized as being “correctly aligned” or “not correctly aligned” for all the parameters described. The rate of “correctly aligned” TAA’s was compared between cases with PSI and those with SI. Fisher’s exact test was used to analyze difference by groups. A significance of 5% was used. Results: Of a total of 67 TAAs included, 51 were in the PSI group and 16 in the SI group. No significant statistically differences were found between PSI and NPSI regarding MDTA (p=0.174), LTS (p=0.922), sDTAA (p=0.986), gamma angle (p=0.252) and TTA (p=0.145). We did not find a significant statistical difference in the rate of “correctly aligned TAR” when we compared both groups (p=0.35). Conclusion: This study suggests that both PSI and SI provide accurate and reproducible TAA radiographic alignment when performed by experienced surgeons. In view of previously published data demonstrating high levels of reproducibility for PSI in TAA, these data also suggest that PSI may offer a means for less experienced surgeons to achieve radiographic results similar to those achieved by experienced surgeons. It also suggests that experienced surgeons may not need to use PSI to achieve satisfactory implant alignment, though improved time efficiency with PSI, as demonstrated in other studies, may still be of benefit for experienced surgeons.

scholarly journals The cost-effectiveness of the SPHERE intervention for the secondary prevention of coronary heart disease

2010 ◽  
Vol 26 (3) ◽  
pp. 263-271 ◽  
Author(s):  
Paddy Gillespie ◽  
Eamon O'Shea ◽  
Andrew W. Murphy ◽  
Mary C. Byrne ◽  
Molly Byrne ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cost Effectiveness ◽  
Secondary Prevention ◽  
Intervention Strategy ◽  
Cost Savings ◽  
Decision Makers ◽  
Level Of Evidence ◽  
Care Plans ◽  
Life Years ◽  
The Cost

Objectives: The Secondary Prevention of Heart disEase in geneRal practicE (SPHERE) trial has recently reported. This study examines the cost-effectiveness of the SPHERE intervention in both healthcare systems on the island of Ireland.Methods: Incremental cost-effectiveness analysis. A probabilistic model was developed to combine within-trial and beyond-trial impacts of treatment to estimate the lifetime costs and benefits of two secondary prevention strategies: Intervention - tailored practice and patient care plans; and Control - standardized usual care.Results: The intervention strategy resulted in mean cost savings per patient of €512.77 (95 percent confidence interval [CI], −1086.46–91.98) and an increase in mean quality-adjusted life-years (QALYs) per patient of 0.0051 (95 percent CI, −0.0101–0.0200), when compared with the control strategy. The probability of the intervention being cost-effective was 94 percent if decision makers are willing to pay €45,000 per additional QALY.Conclusions: Decision makers in both settings must determine whether the level of evidence presented is sufficient to justify the adoption of the SPHERE intervention in clinical practice.

Determining the Cost-Savings Threshold and Alignment Accuracy of Patient-Specific Instrumentation in Total Ankle Replacements

2016 ◽  
Vol 38 (1) ◽  
pp. 49-57 ◽  
Author(s):  
Kamran S. Hamid ◽  
Andrew P. Matson ◽  
Benedict U. Nwachukwu ◽  
Daniel J. Scott ◽  
Richard C. Mather ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Saving ◽  
Operative Time ◽  
Threshold Model ◽  
Cost Savings ◽  
Patient Specific ◽  
Tibial Plafond ◽  
Patient Specific Instrumentation ◽  
Time Savings ◽  
Radiographic Alignment

Background: Traditional intraoperative referencing for total ankle replacements (TARs) involves multiple steps and fluoroscopic guidance to determine mechanical alignment. Recent adoption of patient-specific instrumentation (PSI) allows for referencing to be determined preoperatively, resulting in less steps and potentially decreased operative time. We hypothesized that usage of PSI would result in decreased operating room time that would offset the additional cost of PSI compared with standard referencing (SR). In addition, we aimed to compare postoperative radiographic alignment between PSI and SR. Methods: Between August 2014 and September 2015, 87 patients undergoing TAR were enrolled in a prospectively collected TAR database. Patients were divided into cohorts based on PSI vs SR, and operative times were reviewed. Radiographic alignment parameters were retrospectively measured at 6 weeks postoperatively. Time-driven activity-based costing (TDABC) was used to derive direct costs. Cost vs operative time-savings were examined via 2-way sensitivity analysis to determine cost-saving thresholds for PSI applicable to a range of institution types. Cost-saving thresholds defined the price of PSI below which PSI would be cost-saving. A total of 35 PSI and 52 SR cases were evaluated with no significant differences identified in patient characteristics. Results: Operative time from incision to completion of casting in cases without adjunct procedures was 127 minutes with PSI and 161 minutes with SR ( P < .05). PSI demonstrated similar postoperative accuracy to SR in coronal tibial-plafond alignment (1.1 vs 0.3 degrees varus, P = .06), tibial-plafond alignment (0.3 ± 2.1 vs 1.1 ± 2.1 degrees varus, P = .06), and tibial component sagittal alignment (0.7 vs 0.9 degrees plantarflexion, P = .14). The TDABC method estimated a PSI cost-savings threshold range at our institution of $863 below which PSI pricing would provide net cost-savings. Two-way sensitivity analysis generated a globally applicable cost-savings threshold model based on institution-specific costs and surgeon-specific time-savings. Conclusions: This study demonstrated equivalent postoperative TAR alignment with PSI and SR referencing systems but with a significant decrease in operative time with PSI. Based on TDABC and associated sensitivity analysis, a cost-savings threshold of $863 was identified for PSI pricing at our institution below which PSI was less costly than SR. Similar internal cost accounting may benefit health care systems for identifying cost drivers and obtaining leverage during price negotiations. Level of Evidence: Level III, therapeutic study.

scholarly journals CT based PSI blocks for osteotomies around the knee provide accurate results when intraoperative imaging is used

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Peter Savov ◽  
Mara Hold ◽  
Maximilian Petri ◽  
Hauke Horstmann ◽  
Christian von Falck ◽  
...  
Keyword(s):  
Intraoperative Imaging ◽  
Patient Specific ◽  
Safe Procedure ◽  
Level Of Evidence ◽  
Patient Specific Instrumentation ◽  
Fluoroscopic Control ◽  
Intraoperative Fluoroscopy ◽  
The Mean ◽  
Low Volume ◽  
High Degree

Abstract Purpose Correction osteotomies around the knee are common methods for the treatment of varus or valgus malalignment of the lower extremity. In recent years, patient specific instrumentation (PSI) guides were introduced in order to enhance the accuracy of these procedures. The purpose of this study was to determine the accuracy of CT based PSI guides for correction osteotomies around the knee of low volume osteotomy surgeons and to evaluate if CT based PSI blocks deliver a high degree of accuracy without using intraoperative fluoroscopy. Methods Two study arms with CT based PSI cutting blocks for osteotomies around the knee were conducted. Part one: A retrospective analysis of 19 osteotomies was made in order to evaluate the accuracy in the hands of a low volume surgeon on long-leg radiographs. Part two: A cadaveric study with 8 knees was performed for the purpose of analyzing the accuracy without using intraoperative fluoroscopy on pre- and postoperative CT scans. Hip-Knee-Ankle angle (HKA), lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were analyzed. The mean absolute delta (∂) between the planned and postoperative parameters were calculated. The accuracy of both study arms were compared. Results Part one: The mean MPTA ∂, LDFA ∂ and HKA ∂ was 0.9°, 1.9° and 1.5°, respectively. Part two: The mean MPTA ∂ and LDFA ∂ was 3.5° and 2.2°, respectively. The mean ∂ of MPTA is significantly different between clinical patients with fluoroscopic control and cadaveric specimens without fluoroscopic control (P < 0.001). All surgeries were performed without complications such as a hinge fracture. Conclusion The clinical use of PSI guides for osteotomies around the knee in the hands of low volume surgeons is a safe procedure. The PSI guides deliver a reliable accuracy under fluoroscopic control whereas their non-use of intraoperative fluoroscopy leads to a lack of accuracy. The use of fluoroscopic control during PSI guided correction osteotomies is highly recommended. Level of evidence IV – Retrospective and experimental Study

scholarly journals TRENDS IN UNICOMPARTMENTAL KNEE ARTHROPLASTY

2020 ◽  
Vol 28 (1) ◽  
pp. 19-21 ◽  
Author(s):  
Ahmet Nadir Aydemir ◽  
Mehmet Yucens
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Case Reports ◽  
Research Articles ◽  
Patient Specific ◽  
Level Of Evidence ◽  
Specific Level ◽  
Unicompartmental Knee ◽  
Patient Specific Instrumentation ◽  
Thomson Reuters

ABSTRACT Objective: To evaluate trends in publications on unicompartmental knee arthroplasty (UKA) from the past to the present. Methods: As a web-based analysis, all UKA research articles, editorial letters, case reports, reviews and meeting abstracts published on the Thomson Reuters’ Web of Knowledge were evaluated. The period from the first publication in 1980 to January 2019 was divided into four decades and publications were evaluated. Research articles were grouped into headings according to the subjects. Results: A total of 1,658 publications were evaluated in this study. The most frequent term used in the publications title was “outcome,” with 260 items, followed by “biomechanics and kinematics,” with 99 items. Most reports have been published in the last decade, and the most common type of publication was postoperative follow-up and results. Conclusion: In parallel with technological advancements, publications related to UKA-especially patient-specific instrumentation, navigation, and robotic surgery-will increase in number and become more specific. Level of Evidence V, Expert Opinion.

Intraoperative Assessment of the Axial Rotational Positioning of a Modern Ankle Arthroplasty Tibial Component Using Preoperative Patient-Specific Instrumentation Guidance

2019 ◽  
Vol 40 (10) ◽  
pp. 1160-1165
Author(s):  
Oliver J. Gagne ◽  
Andrea Veljkovic ◽  
Dave Townshend ◽  
Alastair Younger ◽  
Kevin J. Wing ◽  
...  
Keyword(s):  
Tibial Component ◽  
Rotation Angle ◽  
Pearson Correlation ◽  
Case Series ◽  
Axial Rotation ◽  
Patient Specific ◽  
P Value ◽  
Level Of Evidence ◽  
Patient Specific Instrumentation ◽  
Preoperative Ct

Background: The use of patient-specific instrumentation (PSI) in modern total ankle replacement (TAR) has augmented positioning of the tibial component, eliminating the need for complex jigs. Coronal and sagittal alignment are intuitive with this design and have been studied, but axial rotation has not. The purpose of this study was to assess the relationship between the planned preoperative axial rotation as set by the PSI guide and the rotation determined intraoperatively with non-PSI instrumentation. Methods: This was a prospective cohort study of 22 consecutive cases. The axial rotation angle between the medial gutter and the tibial implant position on the preoperative CT-scan based plan was extracted. At the time of surgery, the medial gutter alignment instrument from the non-PSI instrumentation was inserted and an intraoperative axial photograph obtained to record the angle between the medial gutter and the axial rotation guide pins set by the PSI instrumentation. The 2 measurements were compared and further statistical analysis included Pearson correlation and paired Student t test. Results: The average axial rotation angle between the medial gutter and the implant on the PSI preoperative plan was 5.4 ± 2.9 degrees, whereas the intraoperative photograph from the medial gutter alignment instrument to the pin was 5.9 ±3.8 degrees. This demonstrated a Pearson correlation of R = 0.54 and a P value of .53. The average difference between the two was −0.46 (95% CI: –2.04, 1.10), meaning that components were either slightly externally rotated or that the fork was aimed internally. Based on this group, 50% (11/22) were within 2 degrees of the target and 77% (17/22) were within 4 degrees of the target. Conclusion: Patient-specific guides allowed for reproducible rotational tibial component implantation in modern TAR. Further work is needed to better understand the biomechanical effects of the rotational profile and consequences on survivorship. Level of Evidence: Level IV, case series.

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