New research from Massachusetts General Hospital and Harvard Medical School has examined the effect of crosslinked polyethylene implants in total hip arthroplasty (THA) on the costs of hip replacement surgery.
The investigators looked at revision and dislocation rates for crosslinked poly implants in arriving at their conclusions.
The work, “The Role of Crosslinked Polyethylene in Reducing Aggregated Costs of Total Hip Arthroplasty in the United States,” appears in the February 27, 2019 edition of The Journal of Arthroplasty.
The researchers conducted a literature review looking at “contrasting mid-term rates of revisions and dislocations of total hip arthroplasty using conventional polyethylene vs those using crosslinked polyethylene, specifically only registry studies and prospective, randomized controlled studies, we multiplied these incidence figures by the cost estimates of these failures to generate approximations of the cost savings in the United States from the use of crosslinked polyethylene.”
Co-author William H. Harris, M.D., D.Sc., the Alan Gerry Clinical Professor of Orthopaedic Surgery, Emeritus at Harvard Medical School and Massachusetts General Hospital in Boston, Massachusetts, told OTW, “Until the AJRR [American Joint Replacement Registry] has a chance to expand further to encompass the entire country, all figures for both the number of total hip revisions done in the United States per year and also the cost per vision will remain, of necessity, gross estimates.”
“Within that limitation, a useful working figure for annual number of total hip revisions done in the USA is about 50,000. Similarly, a useful working figure for the average cost per revision, including those costs during the year before the revision and costs through the 13 months following the revision, is about $50,000. Thus, the estimated aggregate annual health costs to the community for revisions of total hip surgery for all causes is $2.5 billion.”
“Worldwide data from the most accurate studies (i.e., registry data or prospective randomized controlled studies) show that crosslinked polyethylene has reduced the ‘all cause’ total hip revision rate in half over the first 15 years after insertion compared to comparable cases done using conventional polyethylene. We chose to use a more conservative figure just 40% reduction, to make our estimate calculate on the low side of the likely number.”
“These data indicate that the aggregated annual savings from these reductions would be $1 billion. Although the costs are less in most other countries, more total hips are done outside the USA than in the USA, so perhaps a comparable saving exists in the rest of the world as well.”
“We knew that the revision rate was reduced a lot, but to find the full extent of these savings from the use of crosslinked polyethylene for total hip surgery, was surprising. Not only are the patients very much better off and freed of much of the fear of requiring a reoperation, this is a singular example of simultaneous patient care improvement and cost reduction.”
