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J Knee Surg
DOI: 10.1055/a-2265-9979
Original Article

Are Femoral Stems in Primary Total Knee Arthroplasty Cost Effective in High Fracture Risk Patients? A Risk Model and Cost Analysis

Forrest Rackard
1   Department of Orthopedic Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts
,
Noah Gilreath
2   University of Massachusetts Chan Medical School, Worcester, Massachusetts
,
Ignacio Pasqualini
3   Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Robert Molloy
3   Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Viktor Krebs
3   Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Nicolas S. Piuzzi 
3   Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Matthew E. Deren
3   Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations Funding None.
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Abstract

Femoral stemmed total knee arthroplasty (FS TKA) may be used in patients deemed higher risk for periprosthetic fracture (PPF) to reduce PPF risk. However, the cost effectiveness of FS TKA has not been defined. Using a risk modeling analysis, we investigate the cost effectiveness of FS in primary TKA compared with the implant cost of revision to distal femoral replacement (DFR) following PPF. A model of risk categories was created representing patients at increasing fracture risk, ranging from 2.5 to 30%. The number needed to treat (NNT) was calculated for each risk category, which was multiplied by the increased cost of FS TKA and compared with the cost of DFR. The 50th percentile implant pricing data for primary TKA, FS TKA, and DFR were identified and used for the analysis. FS TKA resulted in an increased cost of $2,717.83, compared with the increased implant cost of DFR of $27,222.29. At 50% relative risk reduction with FS TKA, the NNT for risk categories of 2.5, 10, 20, and 30% were 80, 20, 10, and 6.67, respectively. At 20% risk, FS TKA times NNT equaled $27,178.30. A 10% absolute risk reduction in fracture risk obtained with FS TKA is needed to achieve cost neutrality with DFR. FS TKA is not cost effective for low fracture risk patients but may be cost effective for patients with fracture risk more than 20%. Further study is needed to better define the quantifiable risk reduction achieved in using FS TKA and identify high-risk PPF patients.

Keywords

total knee arthroplasty - revision total knee arthroplasty - periprosthetic fracture - distal femoral stem - implant cost


Publication History

Received: 12 September 2023

Accepted: 08 February 2024

Accepted Manuscript online:
09 February 2024

Article published online:
11 March 2024

© 2024. Thieme. All rights reserved.

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