All-Polyethylene Tibia: An Opportunity for Value-Based Care in Bundled Reimbursement Initiatives

Area of Science:

• Orthopedics
• Health Economics
• Medical Device Technology

Background:

• The Centers for Medicare & Medicaid Services emphasize cost-effective healthcare decisions.
• All-polyethylene tibial (APT) components are a potentially less expensive option for total knee arthroplasty (TKA).

Purpose of the Study:

• To evaluate the cost savings associated with APT components in TKA.
• To assess the impact of APT components on 90-day quality outcome metrics.

Main Methods:

• Retrospective review of primary TKAs performed between 2015-2017 at a single tertiary referral center.
• Patients were stratified by APT versus metal-backed components.
• Univariable and multivariable analyses were used to compare costs and outcomes.

Main Results:

• A total of 188 primary TKAs were analyzed (92 APT, 96 metal-backed).
• APT components were associated with significantly shorter operative times and lower direct surgery costs.
• Total hospital costs showed an average savings of 6.2% with APT components.
• No significant differences were observed in 90-day emergency department visits or re-admissions between the groups.

Conclusions:

• The use of APT components in TKA leads to significant cost reductions in both surgical and total hospital admission costs.
• APT components maintain equivalent 90-day quality outcome metrics compared to metal-backed components.
• Considering APT components for appropriately selected patients is a viable cost-saving strategy given the rising incidence of TKA.