Non-invasive, Zip Type Skin Closure Device vs. Conventional Staples in Total Knee Arthroplasty: Which Method Holds Greater Potential for Bundled Payments?

Purpose. To compare the efficacy and safety of zip-type skin closure device (SCD) and staple in total knee arthroplasty (TKA). Methods. Potential academic articles were identified from PubMed, Springer, ScienceDirect, and Cochrane Library from the inception of electronic databases to July 2020. The statistical analyses were performed with RevMan 5.1. Results. One randomized controlled trial (RCT) and 5 non-RCTs met the inclusion criteria. Present meta-analysis reveals that SCD is associated with lower wound pain score, scar score, and readmission compared with a staple. No significant differences are identified in terms of wound total complications, dehiscence, blisters, and infection. Conclusions. Comparing with a staple, zip-type SCD is a less painful skin closure method with fewer medical cost undergoing TKA.

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A Novel Skin Closure Device for Total Knee Arthroplasty: Randomized Controlled Trial versus Staples

The Journal of Knee Surgery ◽

10.1055/s-0039-1692628 ◽

2019 ◽

Vol 33 (11) ◽

pp. 1116-1120 ◽

Cited By ~ 1

Author(s):

Rodney W. Benner ◽

Jonathan P. Behrens

Keyword(s):

Total Knee Arthroplasty ◽

Randomized Controlled Trial ◽

Knee Arthroplasty ◽

Physical Therapist ◽

Controlled Trial ◽

Closure Device ◽

Skin Closure ◽

Randomized Controlled ◽

Pain Scores ◽

Total Knee

AbstractTwenty-five patients undergoing simultaneous, bilateral total knee arthroplasty (TKA) were randomized to receive skin closure with Zip device on one knee and staples on the other. Patients' pain and scar appearance were rated from 0 (best) to 10 (worst). Knee arc of motion was measured by a physical therapist. At 2 weeks postoperatively, pain scores were significantly better with the Zip device during device wear (p = 0.03) and during device removal (p = 0.003); arc of motion was significantly better with the Zip device (p = 0.002). At 8 weeks of follow-up, scar appearance was significantly better in the Zip device knee as rated by the patients (1.3 vs. 2.6, p = 0.04), the surgeon (1.9 vs. 3.3, p = 0.0006), and three independent plastic surgeons (3.7 vs. 4.8, p < 0.001). Results of this randomized controlled trial show that skin closure with the Zip device resulted in less pain and better scar appearance and knee arc of motion than with staples.

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THE "GENUFLEX" SKIN CLOSURE FOR TOTAL KNEE ARTHROPLASTY

Orthopedics ◽

10.3928/0147-7447-19920901-11 ◽

1992 ◽

Vol 15 (9) ◽

pp. 1057-1058

Author(s):

Thomas V King ◽

Gary Kish ◽

Robert E Eberhart ◽

Jonathan L Holzaepfel

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Skin Closure ◽

Total Knee

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2020 John N. Insall Award: Removal of total knee arthroplasty from the inpatient-only list adversely affects bundled payment programmes

The Bone & Joint Journal ◽

10.1302/0301-620x.102b6.bjj-2019-1369 ◽

2020 ◽

Vol 102-B (6_Supple_A) ◽

pp. 19-23 ◽

Cited By ~ 5

Author(s):

Michael Yayac ◽

Nicholas Schiller ◽

Matthew S. Austin ◽

P. Maxwell Courtney

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Hospital Inpatient ◽

Target Price ◽

Bundled Payment ◽

Bundled Payments ◽

Medicare Patients ◽

Total Knee ◽

Care Improvement ◽

The Impact

Aims The purpose of this study was to determine the impact of the removal of total knee arthroplasty (TKA) from the Medicare Inpatient Only (IPO) list on our Bundled Payments for Care Improvement (BPCI) Initiative in 2018. Methods We examined our institutional database to identify all Medicare patients who underwent primary TKA from 2017 to 2018. Hospital inpatient or outpatient status was cross-referenced with Centers for Medicare & Medicaid Services (CMS) claims data. Demographics, comorbidities, and outcomes were compared between patients classified as ‘outpatient’ and ‘inpatient’ TKA. Episode-of-care BPCI costs were then compared from 2017 to 2018. Results Of the 2,135 primary TKA patients in 2018, 908 (43%) were classified as an outpatient and were excluded from BPCI. Inpatient classified patients had longer mean length of stay (1.9 (SD 1.4) vs 1.4 (SD 1.7) days, p < 0.001) and higher rates of discharge to rehabilitation (17% vs 3%, p < 0.001). Post-acute care costs increased when comparing the BPCI patients from 2017 to 2018, ($5,037 (SD $7,792) vs $5793 (SD $8,311), p = 0.010). The removal of TKA from the IPO list turned a net savings of $53,805 in 2017 into a loss of $219,747 in 2018 for our BPCI programme. Conclusions Following the removal of TKA from the IPO list, nearly half of the patients at our institution were inappropriately classified as an outpatient. Our target price was increased and our institution realized a substantial loss in 2018 BPCI despite strong quality metrics. CMS should address its negative implications on bundled payment programmes. Cite this article: Bone Joint J 2020;102-B(6 Supple A):19–23.

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