Knee News

During the decades before and after total knee arthroplasty, published results showed black women had significantly poorer physical function compared with white women. In addition, poorer physical function after surgery was associated with poorer preoperative physical function.

Despite a high prevalence of self-reported nuisance symptoms after total joint arthroplasty, published results showed these symptoms had a minimal impact on overall patient satisfaction.

Yearly zoledronic acid infusions did not significantly reduce cartilage volume loss in 24 months among patients with symptomatic knee osteoarthritis and bone marrow lesions compared with placebo, according to published results.

After adjusting for expected ratios and patient characteristics across the United States, investigators found regional variation in rates of total knee arthroplasty remained, suggesting overuse of the procedure in some areas.

Results of a matched cohort comparison of 45 patients with medial meniscal root tears who underwent either nonsurgical management, partial meniscectomy or repair showed significant differences among the groups for progression to knee arthroplasty, with the meniscus root repair group having significantly less arthritic progression based on changes in Kellgren-Lawrence grade.

Use of a medially stabilized implant system in patients undergoing total knee arthroplasty yielded superior clinical outcomes compared with a posterior-stabilized implant system, according to results.

Published results showed variation in total inpatient cost between different subspecialties of arthroplasty, with implant cost found to be the main driver of cost variation.

On Jan. 1, 2018, CMS removed total knee arthroplasty from the inpatient-only list for Medicare beneficiaries, which created a significant change for surgeons, patients and hospitals in part due to the implementation of the Two-Midnight Rule. Despite efforts by CMS to provide some clarity in this regard, it remained somewhat unclear to hospitals and physicians which patient cases should be coded as inpatient or outpatient, and many of them were identified on a case-by-case basis where a given surgery would be performed.

It is my understanding that in 2020 the Hospital Outpatient Prospective System rate reimbursement will be $11,899.38 for TKA (CPT code 27447). The final 2020 Ambulatory Payment Classification base rate for CPT code 27447 will be $8,609.17. A ligament reconstruction (CPT code 27429), in comparison, has a reimbursement of $10,717.80. It is my understanding that these rates do not include the professional fee, which is between $1,350 and $1,450 for a TKA. Thus, the reimbursement for a Medicare outpatient TKA is approximately $10,000 including the professional fee. Most orthopedic groups that perform outpatient TKAs state that the average cost including all direct, indirect and variable expenses is approximately $9,000 unless fixed costs are not included in the analysis or if prosthetic costs are reduced significantly. This is not, as yet, a bundled payment reimbursement. If that were the case, it would be imperative for the group to have a “stop loss insurance policy” that would cover the costs of an “unintended complication” in the first 90 days postoperatively. Commercial bundles for TKA typically vary between $18,000 and $27,000. Thus, there is a significant amount of difference between the hospital reimbursement, the Hospital Outpatient Prospective System rate and the ASC base rate for a TKA. Unless a significant number of TKAs with good outcomes at a low cost are ensured, I am not convinced Medicare outpatient ASC TKA is going to become popular among surgeons who have an ownership interest in ASCs. However, bundled payment commercially based outpatient TKA will continue to increase due to the improved profitability and desirability of providing this procedure in optimized patients.

Multiplex polymerase chain reaction, which uses polymerase chain reaction to simultaneously amplify several different next-generation DNA sequences, had 25.6% sensitivity when performed using Musculoskeletal Infection Society criteria for aspirate or tissue samples collected during 93 revision primary total joint arthroplasties and 77 primary total joint arthroplasties, according to study results.