Osmani Feroz A, Bolz Nicholas, Odeh Khalid, Bearison Craig, Schwarzkopf Ran, Iorio Richard
Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Disease, New York, NY, USA.
NYU College of Medicine, New York, NY, USA.
Arthroplast Today. 2017 Oct 21;4(1):94-98. doi: 10.1016/j.artd.2017.08.001. eCollection 2018 Mar.
We sought to develop an objective implant selection guideline based on the ratio of patient body mass index (BMI) to age in order to select implants preoperatively and reduce cost while maintaining quality. The BMI-to-age ratio can be used to distinguish patient demand and select those patients who may benefit from newer technology and higher cost implants and those who would do well with standard-demand implants.
A retrospective analysis investigated the types of implants received by patients undergoing total knee arthroplasty from January 2012 to August 2014. Patients with a BMI-to-age ratio >0.60 were categorized as high demand and were eligible for either a high-demand implant or a standard-demand implant. Patients with a BMI-to-age ratio ≤0.60 were recognized as standard demand and would be eligible for only standard-demand implants. The actual implant received was identified and compared with the implant as predicted by the BMI-to-age ratio and potential cost savings were identified.
A total of 1507 operative knees were identified. The high-demand implant carries a 31% greater cost than that of a standard-demand implant. Thirty-eight of 1084 high-demand implants were placed in standard-demand knees. An additional 1.1% cost was realized with 38 standard-demand knees receiving high-demand implants and 28.6% if high-demand knees had been used in all standard-demand patients.
Limiting the use of high-demand implants to high-functional-demand patients based on the BMI-to-age ratio may guide the surgeon's choice in optimizing implant selection while providing value-based purchasing criteria to the selection of total knee arthroplasty implants.
我们试图制定一项基于患者体重指数（BMI）与年龄之比的客观植入物选择指南，以便在术前选择植入物，在保持质量的同时降低成本。BMI与年龄之比可用于区分患者需求，选择那些可能从新技术和高成本植入物中受益的患者，以及那些使用标准需求植入物就能取得良好效果的患者。
一项回顾性分析调查了2012年1月至2014年8月接受全膝关节置换术患者所使用的植入物类型。BMI与年龄之比>0.60的患者被归类为高需求患者，有资格使用高需求植入物或标准需求植入物。BMI与年龄之比≤0.60的患者被认定为标准需求患者，仅符合使用标准需求植入物的条件。确定实际使用的植入物，并与根据BMI与年龄之比预测的植入物进行比较，确定潜在的成本节约情况。
共确定了1507个手术膝关节。高需求植入物的成本比标准需求植入物高31%。1084个高需求植入物中有38个被植入标准需求膝关节。38个标准需求膝关节接受高需求植入物可额外节省1.1%的成本，如果所有标准需求患者都使用高需求膝关节，则可节省28.6%的成本。
根据BMI与年龄之比将高需求植入物的使用限制于高功能需求患者，可能会指导外科医生在优化植入物选择时做出选择，同时为全膝关节置换植入物的选择提供基于价值的采购标准。
