Bala Abiram, Penrose Colin Thomas, Seyler Thorsten Markus, Mather Richard Chad, Wellman Samuel Secord, Bolognesi Michael Paul
School of Medicine, Duke University School of Medicine, Durham, North Carolina.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
J Knee Surg. 2016 Jul;29(5):430-5. doi: 10.1055/s-0035-1564724. Epub 2015 Oct 19.
Computer-navigated total knee arthroplasty (CN-TKA) has been used to improve component alignment, though the evidence is currently mixed on whether there are clinically significant differences in long-term outcomes. Given the established increased costs and operative time, we hypothesized that the utilization rate of CN-TKA would be decreasing relative to standard TKA in the Medicare population given the current health care economic environment. We queried 1,914,514 primary TKAs performed in the entire Medicare database from 2005 to 2012. Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to identify and separate CN-TKAs. Utilization of TKA was compared by year, gender, and region. Average change in cases per year and compound annual growth rate (CAGR) were used to evaluate trends in utilization of the procedure. We identified 30,773 CN-TKAs performed over this time period. There was an increase in utilization of CN-TKA per year from 984 to 5,352 (average = 572/year, R (2) = 0.85, CAGR = 23.58%) from 2005 to 2012. In contrast, there was a slight decrease in overall TKA utilization from 264,345 to 230,654 (average = 4297/year, R (2) = 0.74, CAGR = - 1.69%). When comparing proportion of CN-TKA to all TKAs, there was an increase from 0.37 to 2.32% (average 0.26%/year, R (2) = 0.88, CAGR = 25.70%). CN-TKA growth in males and females was comparable at 24.42 and 23.11%, respectively. The South region had the highest growth rate at 28.76%, whereas the Midwest had the lowest growth rate at 15.51%. The Midwest was the only region that peaked (2008) with a slow decline in utilization until 2012. Despite increased costs with unclear clinical benefit, CN-TKA is increasing in utilization among Medicare patients. Reasons could include patient preference, advertising, proper of coding the procedure, and increased publicly available information about arthroplasty options.
计算机导航全膝关节置换术（CN-TKA）已被用于改善假体对线，尽管目前关于其长期疗效是否存在临床显著差异的证据并不一致。鉴于已确定的成本增加和手术时间延长，我们推测，在当前的医疗经济环境下，相对于标准全膝关节置换术（TKA），医疗保险人群中CN-TKA的使用率将会下降。我们查询了2005年至2012年整个医疗保险数据库中进行的1,914,514例初次全膝关节置换术。使用当前程序术语（CPT）和国际疾病分类第九版临床修订本（ICD-9-CM）编码来识别和区分CN-TKA。按年份、性别和地区比较全膝关节置换术的使用率。每年病例数的平均变化和复合年增长率（CAGR）用于评估该手术使用率的趋势。我们确定在此期间共进行了30,773例CN-TKA。从2005年到2012年，CN-TKA的使用率逐年上升，从984例增至5,352例（平均每年572例，R(2)=0.85，CAGR=23.58%）。相比之下，全膝关节置换术的总体使用率略有下降，从264,345例降至230,654例（平均每年4297例，R(2)=0.74，CAGR=-l.69%）。当比较CN-TKA在所有全膝关节置换术中的比例时，该比例从0.37%增至2.32%（平均每年0.26%，R(2)=0.88，CAGR=25.70%）。男性和女性中CN-TKA的增长率相当，分别为24.42%和23.11%。南部地区的增长率最高，为28.76%，而中西部地区的增长率最低，为15.51%。中西部是唯一在2008年达到峰值且直到2012年使用率缓慢下降的地区。尽管成本增加且临床益处不明确，但医疗保险患者中CN-TKA的使用率仍在上升。原因可能包括患者偏好、广告宣传、手术编码恰当以及关于关节置换术选择的公开信息增多。
