Sind höhere Preise für größere Kopfdurchmesser in der Hüftendoprothetik medizinökonomisch vertretbar? Eine Analyse der Kosten und Effekte in Deutschland

Zusammenfassung

Hintergrund: In der Hüftendoprothetik stellte der Kopfdurchmesser bisher keinen Parameter dar, dessen Wiederherstellung bei der Rekonstruktion von Biomechanik und Gelenkgeometrie angestrebt wird. Neben kontroversen Diskussionen über Vor- und Nachteile größerer Köpfe scheinen deren meist höhere Kosten eine wesentliche Ursache für einen bisher begrenzten Einsatz darzustellen. Das Ziel dieser Studie bestand darin, die Preisstruktur von Endoprothesenköpfen im Vergleich zu anderen Hüftendoprothesenkomponenten zu analysieren. Darüber hinaus sollte die Verteilung realisierbarer Kopfdurchmesser an einem großen Patientenkollektiv als Basis für eine Mischkalkulation ermittelt werden.

Material und Methoden: Von 2 großen deutschen Endoprothesenherstellern wurden die Relativpreise verschiedener Endoprothesenkomponenten (Pfannen, Inlays, Schäfte und Köpfe) unter besonderer Berücksichtigung der verschiedenen Größen und Varianten einer Serie erhoben und analysiert. Ein großes mit Hüftendoprothesen versorgtes Patientenkollektiv wurde bez. der implantierten Pfannendurchmesser und der somit theoretisch realisierbaren Kopfdurchmesser ausgewertet.

Ergebnisse: Die Analyse der Preisbildung bei Hüftendoprothesenkomponenten von 2 Herstellern ergab jeweils identische Preise für Pfannen-, Inlay- und Schaftimplantatgrößen einer Serie. Im Gegensatz dazu lagen die Preise für Endoprothesenköpfe mit 36–44 mm Durchmesser in Relation zu 28-mm-Köpfen um 11–50 % höher, während identische Preise die Ausnahme darstellten. Die Verteilung der Kopfdurchmesser bei 2719 HTEP-Implantationen zeigte erhebliche Abweichungen zwischen den real eingesetzten und den theoretisch möglichen Köpfen.

Schlussfolgerungen: Angesichts der nachgewiesenen Vorteile und der lösbaren Nachteile größerer Köpfe in der Hüftendoprothetik sollte die gegenwärtige Praxis der Preisbildung mit höheren Preisen für größere Durchmesser korrigiert und der bewährten Preisbildung aller anderen Komponenten mit identischen Preisen für alle Implantate einer Serie angeglichen werden. Damit wird es zukünftig möglich sein, bei Hüftendoprothesenimplantationen im Rahmen der Rekonstruktion von Biomechanik und Gelenkgeometrie neben den Parametern Beinlänge, femorales Offset und Antetorsion des Schenkelhalses auch die annähernde Wiederherstellung des Hüftkopfdurchmessers anzustreben, um die Behandlungsergebnisse zu optimieren.

Abstract

Background: In total hip arthroplasty (THA), femoral head diameter has not been regarded as a key parameter which should be restored when reconstructing joint biomechanics and geometry. Apart from the controversial discussion on the advantages and disadvantages of using larger diameter heads, their higher cost is another important reason that they have only been used to a limited extent. The goal of this study was to analyse the price structure of prosthetic heads in comparison to other components used in THA. A large group of patients with hip endoprostheses were evaluated with respect to the implanted socket diameter and thus the theoretically attainable head diameter.

Materials and Methods: The relative prices of various THA components (cups, inserts, stems and ball heads) distributed by two leading German manufacturers were determined and analysed. Special attention was paid to different sizes and varieties in a series of components. A large patient population treated with THA was evaluated with respect to the implanted cup diameter and therefore the theoretically attainable head diameter.

Results: The pricing analysis of the THA components of two manufacturers showed identical prices for cups, inserts and stems in a series. In contrast to this, the prices for prosthetic heads with a diameter of 36–44 mm were 11–50 % higher than for 28 mm heads. Identical prices for larger heads were the exception. The distribution of the head diameter in 2719 THA cases showed significant differences between the actually implanted and the theoretically attainable heads.

Conclusion: There are proven advantages in using larger diameter ball heads in THA and the remaining problems can be solved. It is therefore desirable to correct the current pricing practice of charging higher prices for larger components. Instead, identical prices should be charged for all head diameters in a series, as is currently established practice for all other THA components. Thus when reconstructing biomechanics and joint geometry in THA, it should be possible to recover not only leg length, femoral offset and antetorsion of the femoral neck, but also to approximately restore the diameter of the femoral head and thereby optimise the functional outcome.

Schlüsselwörter

Hüftendoprothetik - Kopfdurchmesser - Kosten - Luxationsstabilität - Abrieb

Key words

total hip arthroplasty - prosthetic head diameter - costs - dislocation stability - wear

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