Abstract
Aims
The aim of this study was to compare the actual cost of a cemented and cementless total knee arthroplasty (TKA) procedure.
Materials and Methods
The cost of operative time, implants, cement, and cementing accessories were included in the overall cost of the TKA procedure. Operative time was determined from a previously published study comparing cemented and cementless implants of the same design. The cost of operative time, implants, cement, and cementing accessories was determined from market and institutional data.
Results
Mean operative time for cemented TKA was 11.6 minutes longer for cemented TKA than cementless TKA (93.7 minutes (sd 16.7) vs 82.1 minutes (sd 16.6); p = 0.001). Using a conservative published standard of $36 per minute for operating theatre time cost, the total time cost was $418 higher for cementing TKA. The cost of cement and accessories ranged from $170 to $625. Overall, the calculated cost of cemented TKA is $588 to $1043, depending on technique. The general increased charge for cementless TKA implants over cemented TKA implants was $366.
Conclusion
The overall procedural cost of implanting a cementless TKA is less than implanting a cemented TKA. Cost alone should not be a barrier to using cementless TKA.
Cite this article: Bone Joint J 2019;101-B(7 Supple C):61–63
References
- 1.
No authors listed . Australian Orthopaedic Association National Joint Replacement Registry. Annual Reports. https://aoanjrr.sahmri.com/annual-reports-2018(date last accessed 26 February 2019). Google Scholar - 2.
No authors listed . New Zealand Orthopaedic Association. The New Zealand Joint Registry Ten Year Report, January 1999 to December 2008. https://nzoa.org.nz/system/files/NJR%2010%20Year%20Report.pdf(date last accessed 26 February 2019). Google Scholar - 3. . Why are total knee arthroplasties failing today-has anything changed after 10 years? J Arthroplasty 2014;29:1774–1778. Crossref, Medline, ISI, Google Scholar
- 4. . Trabecular metal in total knee arthroplasty associated with higher knee scores: a randomized controlled trial. Clin Orthop Relat Res 2013;471:3543–3553. Crossref, Medline, ISI, Google Scholar
- 5. . Early failure of cementless porous tantalum monoblock tibial components. J Arthroplasty 2013;28:1505–1508. Crossref, Medline, ISI, Google Scholar
- 6. The Mark Coventry Award: Trabecular metal tibial components were durable and reliable in primary total knee arthroplasty: a randomized clinical trial. Clin Orthop Relat Res 2015;473:34–42. Crossref, Medline, ISI, Google Scholar
- 7. . Midterm results of a porous tantalum monoblock tibia component clinical and radiographic results of 108 knees. J Arthroplasty 2011;26:855–860. Crossref, Medline, ISI, Google Scholar
- 8. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 2009;467:2606–2612. Crossref, Medline, ISI, Google Scholar
- 9. . Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg [Am] 2007;89-A:780–785. Google Scholar
- 10. . Bundled payments in total joint replacement: keeping our care affordable and high in quality. Curr Rev Musculoskelet Med 2017;10:370–377. Crossref, Medline, ISI, Google Scholar
- 11. . Surgeons’ perspectives on premium implants in total joint arthroplasty. Orthopedics 2017;40:e825-e830. Crossref, Medline, ISI, Google Scholar
- 12.
No authors listed . Orthopedic News Network: July 2016 Hip and Knee Implant Review. http://orthopedicnetworknews.com/newsletterarchives.html(date last accessed 6 May 2019). Google Scholar - 13. Can cementing technique reduce the cost of a primary total knee arthroplasty? J Knee Surg 2015;28:183–190. Crossref, Medline, ISI, Google Scholar
- 14. . Understanding costs of care in the operating room. JAMA Surg 2018;153:e176233. Crossref, Medline, ISI, Google Scholar
- 15. A prospective, randomized trial of cemented versus cementless total knee arthroplasty of the same, modern design. J Bone Joint Surg [Am] 2019. (In press) Google Scholar
- 16. . Bone cement and accessories. Medtech 360. Market Insights. Global. Decision Resources Group (DRG), December 2016. https://decisionresourcesgroup.com/report/541197-medtech-bone-cement-and-accessories-medtech-360-market/
(date last accessed 26 February 2019). Google Scholar - 17. . A study of time-dependent operating room fees and how to save $100 000 by using time-saving products. The American Journal of Cosmetic Surgery 2005;22:25–34. Crossref, Google Scholar
- 18. . What does one minute of operating room time cost? J Clin Anesth 2010;22:233–236. Crossref, Medline, ISI, Google Scholar
- 19. . Failure of metal-backed patellar arthroplasty. 47 AGC total knees followed for at least 1 year. Acta Orthop Scand 1991;62:166–168. Crossref, Medline, Google Scholar
- 20. . Fracture/dissociation of the polyethylene in metal-backed patellar components in total knee arthroplasty. J Bone Joint Surg [Am] 1988;70-A:675–679. Google Scholar
- 21. No difference in implant survivorship and clinical outcomes between full-cementless and full-cemented fixation in primary total knee arthroplasty: a systematic review and meta-analysis. Int J Surg 2018;53:312–319. Crossref, Medline, ISI, Google Scholar
- 22. Cementless versus cemented fixation in total knee arthroplasty: usage, costs, and complications during the inpatient period. J Knee Surg 2018.
(Epub ahead of print) PMID: 30396202. Google Scholar - 23. Effect of bundled payments and health care reform as alternative payment models in total joint arthroplasty: a clinical review. J Arthroplasty 2017;32:2590–2597. Crossref, Medline, ISI, Google Scholar
- 24. Cost of joint replacement using bundled payment models. JAMA Intern Med 2017;177:214–222. Crossref, Medline, ISI, Google Scholar
- 25. . Efficiency improvement in the operating room. J Surg Res 2016;204:371–383. Crossref, Medline, ISI, Google Scholar
- 26. . Improving OR efficiency. AORN J 2016;104:121–132. Crossref, Medline, ISI, Google Scholar
- 27. Patient and surgical factors affecting procedure duration and revision risk due to deep infection in primary total knee arthroplasty. BMC Musculoskelet Disord 2017;18:544. Crossref, Medline, ISI, Google Scholar

