Total Knee Arthroplasty: Do Outcomes Differ By Implant Design in the Real World?
Author(s)
Kumar V1, Rasouliyan L1, Long S1, Zema C2, Rao MB1
1OMNY Health, Atlanta, GA, USA, 2Zema Consulting, Huntsville, AL, USA
OBJECTIVES : Clinical trials examining the effect of total knee arthroplasty (TKA) implant design on clinical, functional, and utilization outcomes have yielded conflicting results. Our objective was to evaluate the effect of single-radius (SR) vs. multi-radius (MR) implant design on those outcomes for TKA patients in the real-world setting. METHODS : Clinical data collected over a 4-year period from a large medical institution in the OMNY Medical Device Database was used to identify patient encounters where unilateral TKA was performed. A representative implant system was chosen for SR and MR implant designs, and patients were grouped into respective cohorts. Point estimates and measures of variability were generated for clinical (mortality, postoperative knee pain, postoperative implant removal), functional (non-routine discharge disposition), and utilization outcomes (gross charges [$]; length of stay [LOS]). RESULTS : We divided 1464 patients into SR (N=1135) and MR (N=329) cohorts. Distributions of age, gender, race, and employment status were similar between cohorts. Clinical and functional outcomes were similar between SR and MR cohorts: mortality (% [95% confidence interval]: 1.1% [0.6% - 2.0%] vs 0.3% [0.0% - 2.0%]), postoperative knee pain (0.6% [0.2% - 1.3%] vs 1.2% [0.4% - 3.3%]), postoperative implant removal (0.4% [0.2% - 1.1%] vs 0.0% [0.0% - 1.4%]), non-routine discharge disposition (16.4% [14.3% - 18.7%] vs 16.4% [12.7% - 21.0%]). Utilization was similar between SR and MR cohorts for LOS (mean [SD]: 0.98 [1.38] vs 0.96 [1.53]), while gross charges were slightly higher for the SR cohort (median [Q1, Q3]: $43,879 [$39,392 - $51,851] vs. $39,255 [$35,778 - $42,599]). CONCLUSIONS : Clinical and functional outcomes were similar for patients undergoing TKA using two popular knee implant designs; the SR cohort incurred slightly higher charges than the MR cohort, but this may be specific to the chosen systems. Further research is needed to determine drivers of cost differences and to better characterize outcomes in patients undergoing TKA.
Conference/Value in Health Info
2021-11, ISPOR Europe 2021, Copenhagen, Denmark
Value in Health, Volume 24, Issue 12, S2 (December 2021)
Code
POSB419
Topic
Clinical Outcomes, Economic Evaluation, Real World Data & Information Systems
Topic Subcategory
Clinical Outcomes Assessment, Cost-comparison, Effectiveness, Utility, Benefit Analysis, Distributed Data & Research Networks, Performance-based Outcomes
Disease
Medical Devices, Musculoskeletal Disorders, Surgery