The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
J Arthroplasty. 2020 Feb;35(2):407-412. doi: 10.1016/j.arth.2019.08.063. Epub 2019 Sep 3.
Modern cementless total knee arthroplasty (TKA) designs have shown promising early clinical success; however, concerns exist regarding the higher cost of the cementless implants. The purpose of this study is to evaluate the total facility cost of cementless vs traditional cemented TKA along with the effect of cementless fixation on short-term outcomes.
We reviewed a consecutive series of patients between 2015 and 2017 who underwent either cementless or cemented primary TKA. Itemized facility costs were calculated for every procedure using a time-driven activity-based costing algorithm. Controlling for demographic variables and medical comorbidities, we performed a multivariate analysis to identify independent risk factors for facility costs following TKA. Short-term outcome metrics including complications, readmissions, and patient-reported outcomes were compared between groups.
Among the 2426 primary TKA patients in this study, 119 (4.91%) were performed using cementless implants. When compared to cemented TKA, cementless TKA patients had higher implant costs ($3047.80 vs $2808.73, P < .0001), but lower supply costs ($639.49 vs $815.57, P < .0001) and lower operating room personnel costs ($982.01 vs $1238.26, P < .0001). When controlling for confounding variables, cementless fixation did not have a significant effect on total facility cost or outcomes.
In conclusion, the use of cementless TKA implants did not significantly increase total procedural costs when compared to traditional cemented TKA components at our institution. Our data suggest that the increased cost of a cementless implant is recouped through savings in cost of cement and supplies, as well as shorter operative times. The authors encourage investigators at other institutions to use the authors' methodology to evaluate (preferably in a prospective manner) whether the findings from this study can be corroborated.
现代非骨水泥全膝关节置换术（TKA）设计已显示出有前景的早期临床成功；然而，人们对非骨水泥植入物更高的成本仍存在担忧。本研究的目的是评估非骨水泥与传统骨水泥 TKA 的总设施成本，以及非骨水泥固定对短期结果的影响。
我们回顾了 2015 年至 2017 年间连续接受非骨水泥或骨水泥初次 TKA 的患者系列。使用时间驱动的基于活动的成本核算算法为每个手术计算了详细的设施成本。在控制了人口统计学变量和医疗合并症后，我们进行了多变量分析，以确定 TKA 后设施成本的独立危险因素。比较了两组之间的短期结果指标，包括并发症、再入院和患者报告的结果。
在这项研究的 2426 例初次 TKA 患者中，有 119 例（4.91%）使用了非骨水泥植入物。与骨水泥 TKA 相比，非骨水泥 TKA 患者的植入物成本更高（3047.80 美元比 2808.73 美元，P<.0001），但供应成本更低（639.49 美元比 815.57 美元，P<.0001），手术室人员成本更低（982.01 美元比 1238.26 美元，P<.0001）。在控制混杂变量后，非骨水泥固定对总设施成本或结果没有显著影响。
总之，与我们机构的传统骨水泥 TKA 部件相比，使用非骨水泥 TKA 植入物并不会显著增加手术总费用。我们的数据表明，非骨水泥植入物的成本增加通过节省水泥和供应品的成本以及缩短手术时间得到弥补。作者鼓励其他机构的研究人员使用作者的方法（最好是前瞻性地）评估是否可以证实本研究的结果。
