Total knee arthroplasty: Quality assurance and improved longevity costs less

Area of Science:

• Orthopaedic surgery
• Biomedical engineering
• Health economics

Background:

• Significant cost variations exist for total knee arthroplasty (TKA) implants.
• The relationship between TKA implant cost, supporting evidence, and long-term performance is not well-established.

Purpose of the Study:

• To conduct a cost analysis of TKA consumables.
• To investigate the correlation between TKA implant cost, the level of evidence supporting their use, and implant survivorship data.

Main Methods:

• Collected intra-operative data for 1301 primary, cemented, unilateral TKAs over 13 months.
• Utilized Orthopaedic Data Evaluation Panel (ODEP) ratings for evidence levels and UK National Joint Registry data for survivorship (failure rates).
• Employed Spearman rank correlation to analyze relationships between cost, evidence, and failure rates.

Main Results:

• Mean TKA consumable costs were £1969.08 (with patella resurfacing) and £1846.62 (without).
• A negative correlation (r = -0.47) was found between implant price and ODEP rating, indicating higher cost correlates with weaker evidence.
• A positive correlation was observed between implant price and failure rates at 1, 3, and 5 years (r = 0.55, 0.44, 0.28 respectively).

Conclusions:

• Higher-priced TKA prostheses are associated with lower levels of supporting evidence and increased failure rates.
• The financial justification for higher-cost implants requires robust data demonstrating superior outcomes over established alternatives.