COST-EFFECTIVENESS OF PATELLAR RESURFACING COMPARED WITH NON-RESURFACING IN PRIMARY TOTAL KNEE ARTHROPLASTY
Bibliographic record
Abstract
Background The management of the patella during primary total knee arthroplasty (TKA) is controversial. Despite the majority of patients reporting excellent outcomes following TKA, a common complaint is anterior knee pain. Resurfacing of the patella at the time of initial surgery has been proposed as a means of preventing anterior knee pain, however current evidence, including four recent meta-analyses, has failed to show clear superiority of patellar resurfacing. Therefore, the purpose of this study was to estimate the cost-effectiveness of patellar resurfacing compared to non-resurfacing in TKA. Methods We conducted a cost-effectiveness analysis using a decision analytic model to represent a hypothetical patient cohort undergoing primary TKA. Each patient will receive a TKA either with the Patella Resurfaced or Not Resurfaced. Following surgery, patients can transition to one of three chronic health states: 1) Well Post-operative, 2) Patellofemoral Pain (PFP), or 3) Serious Adverse Event (AE), which we have defined as any event requiring Revision TKA, including: loosening/lysis, infection, instability, or fracture (Figure 1). We obtained revision rates following TKA for both resurfaced and unresurfaced cohorts using data from the 2014 Australian Registry. This data was chosen due to similarities between Australian and North American practice patterns and patient demographics, as well as the availability of longer term follow up data, up to 14 years postoperative. Our effectiveness outcome for the model was the quality-adjusted life year (QALY). We used utility scores obtained from the literature to calculate QALYs for each health state. Direct procedure costs were obtained from our institution9s case costing department, and the billing fees for each procedure. We estimated cost-effectiveness from a Canadian publicly funded health care system perspective. All costs and quality of life outcomes were discounted at a rate of 5%. All costs are presented in 2015 Canadian dollars. Results Our cost-effectiveness analysis suggests that TKA with patella resurfacing is a dominant procedure. Patients who receive primary TKA with non-resurfaced patella had higher associated costs over the first 14 years postoperative ($16,182 vs $15,720), and slightly lower quality of life (5.37 QALYs vs 6.01 QALYs). The revision rate for patellar resurfacing was 1.3%. If the rate of secondary resurfacing procedures is 0.5% or less, there is no difference in costs between the two procedures. Discussion Our results suggest that, up to 14 years postoperative, resurfacing the patella in primary TKA is cost-effective compared to primary TKA without patellar resurfacing, due to the higher revision rate in this cohort of patients for secondary resurfacing. Our sensitivity analysis suggests that, among surgical practices that do not routinely perform secondary resurfacing procedures (estimated rate at our institution is 0.3%) there is no significant difference in costs. Although our results suggest that patella resurfacing results in higher quality of life, our model is limited by the availability and validity of utility outcome estimates reported in the literature for the long term follow up of patients following TKA with or without patella resurfacing and secondary resurfacing procedures.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".