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Does Femoral Component Cementation Affect Costs or Clinical Outcomes After Hip Arthroplasty in Medicare Patients?
Jason H Oh1, William W Yang1, Tara Moore1
1Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY.
Insights
Cemented femoral fixation in total hip arthroplasty is associated with better discharge outcomes and trends toward lower costs, readmissions, and reoperations compared to cementless fixation for Medicare patients.
Area of Science:
- Orthopedic Surgery
- Health Economics
- Healthcare Policy
Background:
- Bundled payment initiatives aim to reduce healthcare costs and improve care quality.
- Femoral fixation strategy (cemented vs. cementless) in total hip arthroplasty is a modifiable factor impacting cost and quality.
- Analysis of Centers for Medicare and Medicaid Services (CMS) bundled payment data provides insights into fixation strategies.
Purpose of the Study:
- To evaluate the influence of cemented versus cementless femoral fixation on key outcomes in Medicare total hip arthroplasty (THA) patients.
- To assess the impact on 90-day costs, readmission rates, reoperation rates, length of stay (LOS), and discharge disposition.
- To compare fixation strategies within the context of bundled payment models.
Main Methods:
- Retrospective study of 1671 primary THA Medicare cases.
- Comparison of 359 patients with cemented femoral fixation versus 1312 patients with cementless fixation.
- Utilized CMS cost and clinical data; employed multiple regression models to adjust for baseline demographic differences.
Main Results:
- Cemented fixation was significantly associated with higher likelihood of home discharge compared to cementless fixation.
- Cemented fixation demonstrated trends toward lower costs, reduced readmission rates, and shorter LOS.
- All early postoperative reoperations occurred in the cementless fixation cohort.
Conclusions:
- Cemented femoral fixation showed superior discharge disposition and trends toward better LOS, readmission, cost, and reoperation rates in Medicare THA patients.
- Cemented fixation remains a relevant and effective option despite the increasing popularity of cementless fixation.
- Findings support consideration of cemented fixation within bundled payment models for THA.
Background:
Bundled payment initiatives were introduced to reduce costs and improve quality of care. Cemented vs cementless femoral fixation is a modifiable variable that may influence the cost and quality of care. New bundled payment data from the Centers for Medicare and Medicaid Services allowed us to study the influence of femoral fixation strategy on (1) 90-day costs; (2) readmission rates; (3) reoperation rates; (4) length of stay (LOS); and (5) discharge disposition for Medicare patients undergoing total hip arthroplasty.
Methods:
We retrospectively studied 1671 primary total hip arthroplasty Medicare cases, comparing 359 patients who received cemented femoral fixation to 1312 patients who received cementless fixation. Centers for Medicare and Medicaid Services cost data as well as clinical data were reviewed. Demographic differences were present between the 2 cohorts. Statistical analyses were performed, including multiple regression models to adjust for baseline differences.
Results:
Controlling for cohort differences, cemented patients were significantly more likely to be discharged home compared to cementless patients. Cemented patients also demonstrated trends toward lower costs, lower readmission rates, and shorter LOS compared to cementless patients. All reoperations within the early postoperative period occurred in patients managed with cementless femoral fixation.
Conclusion:
Among Medicare patients, cemented femoral fixation outperformed cementless fixation with respect to discharge disposition and also trended toward superiority with regards to LOS, readmission, cost of care, and reoperation. Cemented femoral fixation remains relevant and useful despite the rising popularity of cementless fixation.
