Cemented monopolar implants may yield lower costs in hemiarthroplasty for hip fracture
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In a retrospective review, researchers found use of bipolar and press-fit implants in hemiarthroplasty for treatment of hip fractures increased construct costs and had little evidence of improved outcomes compared with the use of cemented monopolar implants.
Among geriatric patients with hip fractures treated with hemiarthroplasty at three metropolitan trauma institutions between 2006 and 2018, Brian Cunningham, MD, FAAOS, and colleagues examined construct type, operating surgeon, total operative time and the sum cost of all implants used in 940 hemiarthroplasty surgeries. Researchers determined implant cost based on cross-referencing implant model numbers across charge master databases from all the institutions and standardized these to uniform component costs. Researchers also adjusted all cost values for inflation to 2018 values.
Results showed all hemiarthroplasty procedures had an average operative time of approximately 88.1 minutes. When stratified by construct type, researchers found use of monopolar press-fit constructs in 4.2% of patients, monopolar cemented construct in 55.7% of patients, bipolar press-fit constructs in 11.4% of patients and bipolar cemented constructs in 28.7% of patients. On average, bipolar press-fit constructs were the most expensive at $3,900.61 followed by bipolar cemented constructs at $3,082.51, monopolar press-fit constructs at $2,721.03 and monopolar cemented constructs at $2,627.24, according to results.
Researchers noted a mean operative time of 87.1 minutes for cemented implants and of 93.6 minutes for press-fit implants. From 2013 to 2018, results showed an increase in the use of monopolar cemented implants from 12.1% to 83.3%, as well as a decrease in bipolar press-fit implants from 57.6% to 1.5%. Both polarity and cement were significant variables in determining the total construct cost and had similar influences on cost, according to results from a multivariable linear regression.
“The AAOS released evidenced-based guidelines which recommended cemented monopolar hemiarthroplasty when indicated and our study shows that since that recommendation in 2013, our system has trended toward that construct, which is significantly less expensive than other options, specifically bipolar or press-fit implants,” Cunningham told Healio Orthopedics. “Importantly, cemented monopolar implants were also not associated with an increase in complication or conversions to [total hip arthroplasty] THA.”
Overall, Cunningham noted surgeons should use cemented monopolar implants when performing hemiarthroplasty to drive value.
“In addition, this approach does not result in a longer operative time, which has previously been reported,” Cunningham said. “Value-based hip fracture care is a critical area of study as our population ages, and this is a big step forward.” – by Casey Tingle
Reference:
Kibble K, et al. ePaper 013. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Disclosure: Cunningham reports he has a spouse employed by CODE Technology and receives research support from Integra.