OBJECTIVES

: The Comprehensive Care for Joint Replacement Model (CJR) from the Center for Medicare and Medicaid services (CMS) and similar programs from other payers makes hospitals and healthcare systems more responsible for better clinical and economical outcomes of total knee arthroplasty (TKA) patients. The objective of the study was to evaluate hospital-related clinical and economical outcomes of a bicruciate 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 2016. Patients with a bicruciate knee system were identified using “journey”-related appropriate keywords from billing records and compared against other TKA patients who did not meet the keywords’ criteria. 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 (except hospital bed-size) and clinical characteristics. Generalized Estimating Equation (GEE) model accounted for hospital bed-size with appropriate distribution and link function. Cost data were inflation-adjusted for 2016 U.S. dollar and rounded to the nearest dollar.

RESULTS

: The study matched 1,692 bicruciate knee system patients with other TKA patients. Length of stay for bicruciate knee patients (mean=2.45 days; CI=2.38-2.52) were significantly lower than other TKA patients (mean=2.66 days; CI=2.59-2.74). Bicruciate knee patients were 35% (OR=1.35; CI=1.13-1.61; p value=<.0001) more likely to be discharged to home/home health care and 41% (OR=0.59; CI=0.48-0.74; p value=<.0001) less likely to be discharged to a Skilled Nursing Facility than other TKA patients. Mean total hospital costs were significantly lower for bicruciate knee patients (mean=$16,187; CI=$15,817-$16,565) than other TKA patients (mean=$17,877; CI=$17,449-$18,315).

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.