Computer-Navigated Total Knee Arthroplasty Utilization

Abstract

Computer-navigated total knee arthroplasty (CN-TKA) has been used to improve component alignment, though the evidence is currently mixed on whether there are clinically significant differences in long-term outcomes. Given the established increased costs and operative time, we hypothesized that the utilization rate of CN-TKA would be decreasing relative to standard TKA in the Medicare population given the current health care economic environment. We queried 1,914,514 primary TKAs performed in the entire Medicare database from 2005 to 2012. Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to identify and separate CN-TKAs. Utilization of TKA was compared by year, gender, and region. Average change in cases per year and compound annual growth rate (CAGR) were used to evaluate trends in utilization of the procedure. We identified 30,773 CN-TKAs performed over this time period. There was an increase in utilization of CN-TKA per year from 984 to 5,352 (average = 572/year, R ² = 0.85, CAGR = 23.58%) from 2005 to 2012. In contrast, there was a slight decrease in overall TKA utilization from 264,345 to 230,654 (average = 4297/year, R ² = 0.74, CAGR = − 1.69%). When comparing proportion of CN-TKA to all TKAs, there was an increase from 0.37 to 2.32% (average 0.26%/year, R ² = 0.88, CAGR = 25.70%). CN-TKA growth in males and females was comparable at 24.42 and 23.11%, respectively. The South region had the highest growth rate at 28.76%, whereas the Midwest had the lowest growth rate at 15.51%. The Midwest was the only region that peaked (2008) with a slow decline in utilization until 2012. Despite increased costs with unclear clinical benefit, CN-TKA is increasing in utilization among Medicare patients. Reasons could include patient preference, advertising, proper of coding the procedure, and increased publicly available information about arthroplasty options.

Keywords

arthroplasty - computer navigation - utilization

• References

• 1 Shan L, Shan B, Suzuki A, Nouh F, Saxena A. Intermediate and long-term quality of life after total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Am 2015; 97 (2) 156-168
• 2 Nguyen LC, Lehil MS, Bozic KJ. Trends in Total Knee Arthroplasty Implant Utilization in the United States. J Arthroplasty 2015; 30 (7) 1292
• 3 Nwachukwu BU, McCormick F, Provencher MT, Roche M, Rubash HE. A comprehensive analysis of Medicare trends in utilization and hospital economics for total knee and hip arthroplasty from 2005 to 2011. J Arthroplasty 2015; 30 (1) 15-18
• 4 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (4) 780-785
• 5 de Steiger RN, Liu YL, Graves SE. Computer navigation for total knee arthroplasty reduces revision rate for patients less than sixty-five years of age. J Bone Joint Surg Am 2015; 97 (8) 635-642
• 6 Anderson KC, Buehler KC, Markel DC. Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 2005; 20 (7) (Suppl. 03) 132-138
• 7 Bäthis H, Perlick L, Tingart M, Lüring C, Zurakowski D, Grifka J. Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 2004; 86 (5) 682-687
• 8 Ishida K, Matsumoto T, Tsumura N , et al. Mid-term outcomes of computer-assisted total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19 (7) 1107-1112
• 9 Weng YJ, Hsu RW, Hsu WH. Comparison of computer-assisted navigation and conventional instrumentation for bilateral total knee arthroplasty. J Arthroplasty 2009; 24 (5) 668-673
• 10 Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A. Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br 2003; 85 (6) 830-835
• 11 Blyth MJ, Smith JR, Anthony IC, Strict NE, Rowe PJ, Jones BG. Electromagnetic navigation in total knee arthroplasty-a single center, randomized, single-blind study comparing the results with conventional techniques. J Arthroplasty 2015; 30 (2) 199-205
• 12 Chowdhry M, Bamne AB, Na YG, Kang YG, Kim TK. Prevalence and predictors of post-operative coronal alignment outliers and their association with the functional outcomes in navigated total knee arthroplasty. J Arthroplasty 2014; 29 (12) 2357-2362
• 13 Hakki S, Saleh KJ, Potty AG, Bilotta V, Oliveira D. Columbus navigated TKA system: clinical and radiological results at a minimum of 5 years with survivorship analysis. Orthopedics 2013; 36 (3) e308-e318
• 14 Browne JA, Cook C, Hofmann AA, Bolognesi MP. Postoperative morbidity and mortality following total knee arthroplasty with computer navigation. Knee 2010; 17 (2) 152-156
• 15 Burnett RS, Barrack RL. Computer-assisted total knee arthroplasty is currently of no proven clinical benefit: a systematic review. Clin Orthop Relat Res 2013; 471 (1) 264-276
• 16 Slover JD, Tosteson AN, Bozic KJ, Rubash HE, Malchau H. Impact of hospital volume on the economic value of computer navigation for total knee replacement. J Bone Joint Surg Am 2008; 90 (7) 1492-1500
• 17 Shi J, Wei Y, Wang S , et al. Computer navigation and total knee arthroplasty. Orthopedics 2014; 37 (1) e39-e43
• 18 Bauwens K, Matthes G, Wich M , et al. Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 2007; 89 (2) 261-269
• 19 Zumstein MA, Frauchiger L, Wyss D, Hess R, Ballmer PM. Is restricted femoral navigation sufficient for accuracy of total knee arthroplasty?. Clin Orthop Relat Res 2006; 451 (451) 80-86
• 20 Jung YB, Lee HJ, Jung HJ, Song KS, Lee JS, Yang JJ. Comparison of the radiological results between fluoroscopy-assisted and navigation-guided total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2009; 17 (3) 286-292
• 21 van Strien T, van der Linden-van der Zwaag E, Kaptein B, van Erkel A, Valstar E, Nelissen R. Computer assisted versus conventional cemented total knee prostheses alignment accuracy and micromotion of the tibial component. Int Orthop 2009; 33 (5) 1255-1261
• 22 Bozic KJ, Smith AR, Hariri S , et al. The 2007 ABJS Marshall Urist Award: the impact of direct-to-consumer advertising in orthopaedics. Clin Orthop Relat Res 2007; 458 (458) 202-219