Schreiner Gabriella, Fucaloro Stephen, Hayes-Lattin Madison, Bragg Jack, Salzler Matthew J
Tufts University School of Medicine, Boston, Massachusetts, U.S.A.
Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A.
Arthroscopy. 2025 Jul 9. doi: 10.1016/j.arthro.2025.06.021.
To assess the cost-effectiveness of performing a remplissage procedure at the time of primary arthroscopic labral repair (ALR) for shoulder dislocations with on- and off-track Hill-Sachs lesions (HSLs).
Baseline costs for ALR, remplissage, and revision surgery, as well as initial failure rate, were collected from the literature for both on- and off-track HSLs. All referenced studies included patients with subcritical glenoid bone loss (<15%). The initial failure rate was defined as the rate of revision surgery for shoulder redislocation. Break-even economic analysis was used to assess the cost-effectiveness of adding remplissage to a primary ALR. To account for the variability in costs and initial failure rates, in addition to procedural differences, across institutions, a wide range of values were used to calculate the absolute risk reduction and number needed to treat to achieve cost-effectiveness. To provide alternate scenarios, sub-analyses with revision remplissage and revision Latarjet procedures were also performed.
Primary remplissage is cost-effective for off-track HSLs if it prevents 1 revision for every 15 primary ALRs (absolute risk reduction, 6.8%; number needed to treat, 15), assuming primary remplissage costs of $982 and revision surgery costs of $14,498. With an initial failure rate of 14.0%, primary remplissage is cost-effective for off-track HSLs when the cost of revision surgery exceeds $7,000 or when primary remplissage costs less than $2,750. For on-track lesions, remplissage is cost-effective at revision surgery costs exceeding $9,632 or when remplissage costs less than $2,000. Sub-analysis of the revision Latarjet procedure similarly showed cost-effectiveness.
Remplissage is a highly cost-effective intervention for off-track HSLs for a wide range of primary and revision surgery costs according to this break-even economic analysis. Remplissage is cost-effective for on-track lesions when the cost of revision surgery is greater than $9,632 or when remplissage costs less than $2,000.
Level IV, economic analysis.
评估在初次关节镜下盂唇修复（ALR）治疗伴有移位和未移位的希尔-萨克斯损伤（HSLs）的肩关节脱位时进行填充手术的成本效益。
从文献中收集ALR、填充手术和翻修手术的基线成本，以及初次失败率，用于移位和未移位的HSLs。所有引用的研究均纳入了关节盂骨丢失不严重（<15%）的患者。初次失败率定义为肩关节再次脱位的翻修手术率。采用盈亏平衡经济分析来评估在初次ALR中增加填充手术的成本效益。为了考虑不同机构之间成本和初次失败率的变异性，以及手术差异，使用了广泛的数值来计算绝对风险降低率和实现成本效益所需的治疗人数。为提供替代方案，还进行了翻修填充手术和翻修拉塔热手术的亚分析。
对于未移位的HSLs，如果每15例初次ALR能预防1例翻修手术（绝对风险降低率为6.8%；所需治疗人数为15），则初次填充手术具有成本效益，假设初次填充手术成本为982美元，翻修手术成本为14498美元。当初次失败率为14.0%时，当翻修手术成本超过7000美元或初次填充手术成本低于2750美元时，初次填充手术对于未移位的HSLs具有成本效益。对于移位损伤，当翻修手术成本超过9632美元或填充手术成本低于2000美元时，填充手术具有成本效益。翻修拉塔热手术的亚分析同样显示出成本效益。
根据这项盈亏平衡经济分析，对于广泛的初次和翻修手术成本，填充手术是治疗未移位HSLs的一种极具成本效益的干预措施。当翻修手术成本大于9632美元或填充手术成本低于2000美元时，填充手术对于移位损伤具有成本效益。
四级，经济分析。
