OBJECTIVES

: The Comprehensive Care for Joint Replacement Model (CJR) from CMS and similar programs from other payers makes hospitals and healthcare systems more responsible for better clinical and economic outcomes of total knee arthroplasty (TKA) patients. The objective of the study was to evaluate hospital-related clinical and economic outcomes of a two premium knee system in TKA patients

METHODS

: We retrospectively reviewed patients who underwent a primary TKA for osteoarthritis from the Premier Perspective Database between 2014 and 2017. Patients with journey II knee system and triathlon knee system identified using appropriate keywords from billing records were included in the study. Patients were excluded if they were <21 years of age; outpatient hospital discharges; evidence of revision TKA; bilateral TKA in same discharge or different discharges. 1:1 propensity score matching was used to control patients, hospital and clinical characteristics. Generalized Estimating Equation model with appropriate distribution and link function were used to estimate hospital related cost while logistic regression models were used to estimate discharged status and 1-year readmission rate.

RESULTS

: The study matched 2,247 journey II knee system patients with triathlon knee system patients. Length of stay for journey II knee system patients (mean=2.26days; CI=2.21-2.31) were significantly lower than triathlon knee system patients (mean=2.49days; CI=2.44-2.54). Journey II knee system patients were 26% (OR=1.26; CI=1.08-1.47; p-value=0.0030) more likely to be discharged to home/home health care, 28% (OR=0.72; CI=0.60-0.86; p-value=0.0003) less likely to be discharged to skilled nursing facility, and 27% (OR=0.73; CI=0.56-0.96; p-value=0.0264) less likely to be readmitted within 1-year than triathlon knee system patients. Mean total hospital costs were significantly lower for journey II knee system patients (mean=$15,165; CI=$14,922-$15,411) than triathlon knee system patients (mean=$15,594; CI=$15,344-$15,848).

CONCLUSIONS

: Hospitals and healthcare professionals can use retrospective real-world data to make informed decisions on knee system choice to reduce hospital cost and improve outcomes in TKA.