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Do More Expensive Total Knee Arthroplasty Prostheses Provide Greater Improvements in Outcomes Over Less Expensive Prostheses Sold by a Physician-owned Distributorship?

Baumgarten, Keith M. MD; Chang, Peter S. MD; Looby, Peter A. MD; McKenzie, Matthew J. MD; Rothrock, Corey P. MD

Journal of the American Academy of Orthopaedic Surgeons: December 1, 2019 - Volume 27 - Issue 23 - p e1059-e1067
doi: 10.5435/JAAOS-D-18-00620
Research Article

Background: It is unknown whether more expensive total knee prostheses provide better improvements in patient-determined outcomes compared with less expensive prostheses. A physician-owned distributorship (POD) was created with a goal to provide lower cost implants to hospitals as an alternative to higher cost prostheses sold by the large orthopaedic implant companies. The hypothesis was that lower cost total knee prostheses would have equivalent outcomes, while resulting in lower costs to the hospitals purchasing them compared with higher cost industry-supplied knee prostheses.

Methods: From May 2013 until January 2015, a POD existed which included five surgeons that performed total knee arthroplasties and were willing to follow the outcomes to ensure quality. The POD sold two knee arthroplasty systems at a cost that was lower than that of the large industry companies. Surgeons were allowed to use either POD knees or industry knees at their own discretion. Patients were followed up prospectively to determine The Knee Injury and Osteoarthritis Outcome Score (KOOS) outcomes at 2 years and any incidence of knee complications that required surgery.

Results: Two hundred-nine knees (35.2%) had a POD knee implanted, and 385 knees had an industry knee implanted. Both POD knees and industry knees showed statistically significant improvements (P < 0.0001) for all subgroups of the KOOS. No statistically significant difference was observed in improvement in any subgroup of the KOOS between the groups. Knee complications requiring surgical intervention were similar (2.9% POD knees versus 3.6% industry knees; P = 0.58). Using lower cost POD knees saved $209,875.71.

Conclusions: No difference was observed in improvements in outcomes or complications in the lower cost POD-supplied knees compared with the higher cost industry-supplied knees. Hospitals and surgeons may consider using lower cost prostheses because the increased cost of the prosthesis has not been correlated to improved outcomes.

Level of Evidence: Level II therapeutic prospective cohort study

From the Orthopedic Institute (Dr. Baumgarten, Dr. Looby, Dr. McKenzie, and Dr. Rothrock), and the University of South Dakota Sanford School of Medicine (Dr. Baumgarten and Dr. Chang), Sioux Falls, SD.

Correspondence to Dr. Baumgarten:

From May 2013 to January 2015, Keith M. Baumgarten, Peter A. Looby, Matthew J. McKenzie, and Corey P. Rothrock had a financial interest in The Great Plains Surgical Distributorship, which is described in this manuscript. Dr. Baumgarten or an immediate family member has received royalties from Wolters Kluwer Health—Lippincott William and Wilkins; is a member of a speakers’ bureau or has made paid presentations on behalf of Wright Medical and Arthrex; serves as a paid consultant to Wright Medical; and serves as a board member, owner, officer, or committee member on the board of the South Dakota State Orthopaedic Society and American Shoulder and Elbow Surgeons. Dr. Looby or an immediate family member has stock or stock options held in Renovis Surgical. Dr. Rothrock is a member of a speakers’ bureau or has made paid presentations on behalf of Zimmer Biomet. 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. Chang and Dr. McKenzie.

Copyright 2019 by the American Academy of Orthopaedic Surgeons.
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