Research Article

Cost Comparison of Femoral Distraction Osteogenesis With External Lengthening Over a Nail Versus Internal Magnetic Lengthening Nail

Richardson, Shawn S. MD; Schairer, William W. MD; Fragomen, Austin T. MD; Rozbruch, S. Robert MD

From the Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY.

Correspondence to Dr. Richardson: [email protected]

Dr. Fragomen or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of NuVasive, Smith & Nephew, and DePuy Synthes; serves as a paid consultant to Globus Medical, NuVasive, Smith & Nephew, and DePuy Synthes; and serves as a board member, owner, officer, or committee member of the Limb Lengthening Research Society. Dr. Rozbruch or an immediate family member has received royalties from Stryker; is a member of a speakers' bureau or has made paid presentations on behalf of and serves as a paid consultant to NuVasive, Smith & Nephew, and Stryker; and serves as a board member, owner, officer, or committee member of the Limb Lengthening Reconstruction Society. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Richardson and Dr. Schairer.

Journal of the American Academy of Orthopaedic Surgeons 27(9):p e430-e436, May 1, 2019. | DOI: 10.5435/JAAOS-D-17-00741

Abstract

Introduction:

Femoral lengthening is performed by distraction osteogenesis via lengthening over a nail (LON) or by using a magnetic lengthening nail (MLN). MLN avoids the complications of external fixation while providing accurate and easily controlled lengthening. However, the increased cost of implants has led many to question whether MLN is cost-effective compared with LON.

Methods:

A retrospective review was performed comparing consecutive femoral lengthenings using either LON (n = 19) or MLN (n = 39). The number of surgical procedures, time to union, and amount of lengthening were compared. Cost analysis was performed using both hospital and surgeon payments. Costs were adjusted for inflation using the Consumer Price Index.

Results:

No difference was observed in the length of femoral distraction. Patients treated with MLN underwent fewer surgeries (3.1 versus 2.1; P < 0.001) and had a shorter time to union (136.7 versus 100.2 days; P = 0.001). Total costs were similar ($50,255 versus $44,449; P = 0.482), although surgeon fees were lower for MLN ($4,324 versus $2,769; P < 0.001).

Discussion:

Although implants are more expensive for MLN than LON, this appears to be offset by fewer procedures. Overall, the two procedures had similar total costs, but MLN was associated with a decreased number of procedures and shorter time to union.