Template-directed Instrumentation in Total Knee Arthroplasty: Cost Savings Analysis

AbstractSince the 2016 implementation of the comprehensive care for joint replacement (CJR) bundled payment model, our institutions have sought to decrease inpatient physical therapy (PT) costs by piloting a mobility technician program (MTP), where mobility technicians (MTs) ambulate postoperative total knee arthroplasty (TKA) patients under the supervision of nursing staff members. MTs are certified medical assistants given specialized gate and ambulation training by the PT department. The aim of this study was to examine the economic and clinical impact of MTs on the primary TKA postoperative pathway. We performed a retrospective review of TKA patients who underwent surgery at our institution between April 2018 and March 2019 and who were postoperatively ambulated by MTs. The control group included patients who had surgery during the same months of the prior year, preceding introduction of MTs to the floor. Inclusion criteria included: unilateral primary TKA for arthritic conditions and conversion to unilateral primary TKA from a previous knee surgery. Minitab Software (State College, PA) was used to perform the statistical analysis. There were 658 patients enrolled in the study group and 1,400 in the control group. The two groups shared similar demographics and an average age of 68 (p = 0.177). The median length of stay (LOS) was 2 days in both groups (p = 0.133) with 90.5% of patients in the study group discharged to home versus 81.5% of patients in the control group (p < 0.001). The ability of MTs to increase patient discharge to home without negatively impacting LOS suggest MTs are valuable both clinically to patients, and economically to the institution. Cost analysis highlighted the substantial cost savings that MTs may create in a bundled payment system. With the well-documented benefits of early ambulation following TKA, we demonstrate how MTs can be an asset to optimizing the care pathway of TKA patients.

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Costs of unicompartmental compared with total knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.103b6.bjj-2020-2259.r1 ◽

2021 ◽

Vol 103-B (6 Supple A) ◽

pp. 23-31

Author(s):

Robert A. Burnett III ◽

JaeWon Yang ◽

P. Maxwell Courtney ◽

E. Bailey Terhune ◽

Charles P. Hannon ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Revision Surgery ◽

Healthcare Costs ◽

Cost Savings ◽

Vein Thrombosis ◽

Total Knee ◽

The Mean ◽

One Year ◽

Surgery Rates

Aims The aim of this study was to compare ten-year longitudinal healthcare costs and revision rates for patients undergoing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). Methods The Humana database was used to compare 2,383 patients undergoing UKA between 2007 and 2009, who were matched 1:1 from a cohort of 63,036 patients undergoing primary TKA based on age, sex, and Elixhauser Comorbidity Index. Medical and surgical complications were tracked longitudinally for one year following surgery. Rates of revision surgery and cumulative mean healthcare costs were recorded for this period of time and compared between the cohorts. Results Patients undergoing TKA had significantly higher rates of manipulation under anaesthesia (3.9% vs 0.9%; p < 0.001), deep vein thrombosis (5.0% vs 3.1%; p < 0.001), pulmonary embolism (1.5% vs 0.8%; p = 0.001), and renal failure (4.2% vs 2.2%; p < 0.001). Revision rates, however, were significantly higher for UKA at five years (6.0% vs 4.2%; p = 0.007) and ten years postoperatively (6.5% vs 4.4%; p = 0.002). Longitudinal-related healthcare costs for patients undergoing TKA were greater than for those undergoing UKA at one year ($24,771 vs $22,071; p < 0.001) and five years following surgery ($26,549 vs $25,730; p < 0.001); however, the mean costs of TKA were comparable to UKA at ten years ($26,877 vs $26,891; p = 0.425). Conclusion Despite higher revision rates, patients undergoing UKA had lower mean healthcare costs than those undergoing TKA up to ten years following the procedure, at which time costs were comparable. In the era of value-based care, surgeons and policymakers should be aware of the costs involved with these procedures. UKA was associated with fewer complications at one year postoperatively but higher revision rates at five and ten years. While UKA was significantly less costly than TKA at one and five years, costs at ten years were comparable with a mean difference of only $14. Lowering the risk of revision surgery should be targeted as a source of cost savings for both UKA and TKA as the mean related healthcare costs were 2.5-fold higher in patients requiring revision surgery. Cite this article: Bone Joint J 2021;103-B(6 Supple A):23–31.

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Transfusion Cost Savings with Tranexamic Acid in Primary Total Knee Arthroplasty from 2009 to 2012

The Journal of Arthroplasty ◽

10.1016/j.arth.2014.10.008 ◽

2015 ◽

Vol 30 (3) ◽

pp. 365-368 ◽

Cited By ~ 27

Author(s):

Joseph T. Moskal ◽

Ryan N. Harris ◽

Susan G. Capps

Keyword(s):

Total Knee Arthroplasty ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Cost Savings ◽

Total Knee ◽

Primary Total Knee

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Accuracy of one-dimensional templating on linear EOS radiography allows template-directed instrumentation in total knee arthroplasty

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02812-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Michael Andreas Finsterwald ◽

Salar Sobhi ◽

Senthuren Isaac ◽

Penelope Scott ◽

Riaz J. K. Khan ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Cost Savings ◽

Consecutive Series ◽

Potential Cost ◽

Templating Method ◽

One Dimensional ◽

Observer Reliability ◽

Implant Size ◽

Total Knee

Abstract Background Templating for total knee arthroplasty (TKA) is routinely performed on two-dimensional standard X-ray images and allows template-directed instrumentation. To date, there is no report on one-dimensional (1D) anteroposterior (AP) templating not requiring specific templating software. We aim to describe a novel technique and explore its reliability, accuracy and potential cost-savings. Methods We investigated a consecutive series of TKAs at one institution between January and July 2019. Patients with preoperative low-dose linear AP EOS radiography images were included. Implant component sizes were retrospectively templated on the AP view with the hospitals imaging viewing software by two observers who were blinded to the definitive implant size. Planning accuracy as well as inter- and intra-observer reliability was calculated. Cost-savings were estimated based on the reduction of trays indicated by the 1D templating size estimations. Results A total of 141 consecutive TKAs in 113 patients were included. Accuracy of 1D templating was as follows: exact match in 53% femoral and 63% tibial components, within one size in 96% femoral and 98% tibial components. Overall 58% of TKA components were planned correctly and 97% within one size. Inter- and intra-rater reliability was good (κ = 0.66) and very good (κ = 0.82), respectively. This templating process can reduce instrumentation from six to three trays per case and therefore halve sterilisation costs. Conclusions The new 1D templating method using EOS AP imaging predicts component sizes in TKA within one size 97% of the time and can halve the number of instrumentation trays and sterilisation costs.

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Cost savings of outpatient versus standard inpatient total knee arthroplasty

Canadian Journal of Surgery ◽

10.1503/cjs.002516 ◽

2017 ◽

pp. 57-62 ◽

Cited By ~ 3

Author(s):

Adrian Huang ◽

Jae-Jin Ryu ◽

Geoffrey Dervin

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Cost Minimization ◽

Cost Savings ◽

Case Control ◽

Published Data ◽

Same Day Discharge ◽

Total Knee ◽

Inpatient Procedure ◽

The Cost

Background: With diminishing reimbursement rates and strained public payer budgets, a high-volume inpatient procedure, such as total knee arthroplasty (TKA), is a common target for improving cost efficiencies. Methods: This prospective case–control study compared the cost-minimization of same day discharge (SDD) versus inpatient TKA. We examined if and where cost savings can be realized and the magnitude of savings that can be achieved without compromising quality of care. Outcome variables, including detailed case costs, return to hospital rates and complications, were documented and compared between the first 20 SDD cases and 20 matched inpatient controls. Results: In every case–control match, the SDD TKA was less costly than the inpatient procedure and yielded a median cost savings of approximately 30%. The savings came primarily from costs associated with the inpatient encounter, such as surgical ward, pharmacy and patient meal costs. At 1 year, there were no major complications and no return to hospital or readmission encounters for either group. Conclusion: Our results are consistent with previously published data on the cost savings associated with short stay or outpatient TKA. We have gone further by documenting where those savings were in a matched cohort design. Furthermore, we determined where cost savings could be realized during the patient encounter and to what degree. In carefully selected patients, outpatient TKA is a feasible alternative to traditional inpatient TKA and is significantly less costly. Furthermore, it was deemed to be safe in the perioperative period.

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Comparative Cost Analysis of Robotic-Assisted and Jig-Based Manual Primary Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1713895 ◽

2020 ◽

Cited By ~ 3

Author(s):

Eric J. Cotter ◽

Jesse Wang ◽

Richard L. Illgen

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Cost Savings ◽

Patient Characteristics ◽

Robotic Assisted ◽

Episode Of Care ◽

Total Knee ◽

Implant System ◽

The Cost

AbstractExcellent durability with traditional jig-based manual total knee arthroplasty (mTKA) has been noted, but substantial rates of dissatisfaction remain. Robotic-assisted TKA (raTKA) was introduced to improve clinical outcomes, but associated costs have not been well studied. The purpose of our study is to compare 90-day episode-of-care (EOC) costs for mTKA and raTKA. A retrospective review of an institutional database from 4/2015 to 9/2017 identified consecutive mTKAs and raTKAs using a single implant system performed by one surgeon. The raTKA platform became available at our institution in October 2016. Prior to this date, all TKAs were performed with mTKA technique. After this date, all TKAs were performed using robotic-assistance without exception. Sequential cases were included for both mTKA and raTKA with no patients excluded. Clinical and financial data were obtained from medical and billing records. Ninety-day EOC costs were compared. Statistical analysis was performed by departmental statistician. One hundred and thirty nine mTKAs and 147 raTKAs were identified. No significant differences in patient characteristics were noted. Total intraoperative costs were higher ($10,295.17 vs. 9,998.78, respectively, p < 0.001) and inpatient costs were lower ($3,893.90 vs. 5,587.40, respectively, p < 0.001) comparing raTKA and mTKA. Length of stay (LOS) was reduced 25% (1.2 vs. 1.6 days, respectively, p < 0.0001) and prescribed opioids were reduced 57% (984.2 versus 2240.4 morphine milligram equivalents, respectively, p < 0.0001) comparing raTKA with mTKA. Ninety-day EOC costs were $2,090.70 lower for raTKA compared with mTKA ($15,629.94 vs. 17,720.64, respectively; p < 0.001). The higher intraoperative costs associated with raTKA were offset by greater savings in postoperative costs for the 90-day EOC compared with mTKA. Higher intraoperative costs were driven by the cost of the robot, maintenance fees, and robot-specific disposables. Cost savings with raTKA were primarily driven by reduced instrument pan reprocessing fees, shorter LOS, and reduced prescribed opioids compared with mTKA technique. raTKA demonstrated improved value compared with mTKA based on significantly lower average 90-day EOC costs and superior quality exemplified by reduced LOS, less postoperative opioid requirements, and reduced postdischarge resource utilization.

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