How can cementless TKAs be a part of your future outpatient TKA practice?
Virtua Joint Replacement Institute, New Jersey
The upcoming removal of total knee replacement from the Medicare Inpatient-Only list will open up opportunities for surgeons to build our own outpatient total knee replacement practice.
Performing an outpatient TKA is a process not an event. It requires a change in culture and team efforts to succeed, but has the potential to lead to significant rewards, both outcomes based and financial. If you are interested in performing an outpatient TKA, I encourage you to start exploring ways to develop a same-day surgery protocol that works for you. At the same time, today’s “renaissance” of cementless TKAs and the potential operating time and cost efficiencies played a big role in building my same-day total knee replacement practice.
How can cementless TKA help shape the future of your practice? I’ll walk you through my experience...
First, patient outcomes are always my top priority. Whether or not you are interested in moving to an outpatient setting, the AAOS Clinical Practice Guidelines support the use of either cementless or cemented tibial baseplates as both fixation techniques demonstrated similar outcomes in multiple clinical studies.1 Recent studies show good outcomes with Triathlon Tritanium cementless TKA2-4 in patients across different age ranges2-5 as well as obese patients6, non-obese patients6, and patients with rheumatoid arthritis.7 This is important as you begin to consider your implant choice and patient selection criteria for both of your inpatient and outpatient practice.
Second, the cost/benefit analysis below for cementless TKA fits my practice goals. Even though cementless implants usually cost more, I have seen the cost savings from elimination of bone cement and the cement mixing device, as well as resultant operating room time. And because of the time savings with cementless TKA, it allowed me to operate on more patients in the same day.
Everyone’s OR workflow and caseload is different but in my experience, performing just one additional case a day makes sense for my practice financially. In addition, the cost of managing inventory for cement and cement mixers can be reduced in cementless TKAs. If you avoided cementless TKA because of the implant cost, I encourage you to perform a similar analysis for your practice.
Living in an era of a rapidly changing health care environment, we should all be looking into ways to improve our practice. In my experience, rapid discharge to home after total knee arthroplasty in appropriate patients has worked well. Below is some data including the Rapid Recovery Protocols in my practice for your reference.8 There are different recovery programs for you to start considering, and cementless TKAs can certainly play a role!
Resources:
Rapid Discharge to Home After Total Knee Arthroplasty Is Safe in Eligible Medicare Patients
Schoifet et al. 2017
Clinical and Radiographic Results of a Highly Porous Titanium Cementless Tibial Baseplate in TKA
Buzhardt et al. 2017
Results of Cemented vs Cementless Primary Total Knee Arthroplasty Using
the Same Implant Design
Miller et al. 2017
References:
- American American Academy of Orthopaedic Surgeons. “Clinical Practice Guidelines - Osteoarthritis of the Knee (Arthroplasty/Surgical Management).” Clinical Practice Guidelines, 12 Apr. 2015, www.aaos.org/cpg/ accessed on April 1, 2018.
- Harwin, Steven F., et al. “Outcomes of Newer Generation Cementless Total Knee Arthroplasty: Beaded Periapatite-Coated vs Highly Porous Titanium-Coated Implants.” The Journal of Arthroplasty, Churchill Livingstone, 3 Feb. 2017, www.sciencedirect.com/science/article/pii/S0883540317300761.
- Miller, Adam J., et al. “Results of Cemented vs Cementless Primary Total Knee Arthroplasty Using the Same Implant Design.” The Journal of Arthroplasty, 2017, doi:10.1016/j.arth.2017.11.048.
- Buzhardt P., “Clinical And Radiographic Results Of A Highly Porous Titanium Cementless Tibial Baseplate In Tka.” Orthopaedic Proceedings, online.boneandjoint.org.uk/doi/abs/10.1302/1358-992X.99BSUPP_3.ISTA2016-056.
- Newman, Jared, et al. “Cementless Total Knee Arthroplasty in Patients Older Than 75 Years.” The Journal of Knee Surgery, vol. 30, no. 09, Nov. 2017, pp. 930–935., doi:10.1055/s-0037-1599253.
- Sharpe, Kipling, et al. “Prospective Assessment of the Impact of Obesity on Early Postoperative Outcomes of Cementless Total Knee Arthroplasty.” AAHKS, Nov. 2017. Dallas Texas., Poster.
- Patel, Nirav K; Khlopas, Anton; Ramkumar, Prem; Chughtai, Morad; Navarro, Sergio M; Berger, Ryan Joseph; Delanois, Ronald Emilio; Roche, Martin William; Mont, Michael A. Outcomes of Cementless Total Knee Arthroplasty in Rheumatoid Arthritis Patients. 2018 AAOS Annual Meeting, 7 – 10 March. New Orleans, LA.
- Klingenstein, Gregory G., et al. “Rapid Discharge to Home After Total Knee Arthroplasty Is Safe in Eligible Medicare Patients.” The Journal of Arthroplasty, vol. 32, no. 11, 2017, pp. 3308–3313., doi:10.1016/j.arth.2017.06.034.
Dr. Schoifet is a paid consultant of Stryker Orthopaedics. The opinions expressed by Dr. Schoifet are those of Dr. Schoifet and not necessarily those of Stryker.
Individual experiences may vary. A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons be trained in the use of any particular product before using it in surgery. The information presented is intended to demonstrate the breadth of Stryker’s product offerings. A surgeon must always refer to the package insert, product label and/or instructions for use before using any of Stryker’s products. Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in individual markets. Please contact your sales representative if you have questions about the availability of products in your area.
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