Клинико-экономический анализ эффективности использования индивидуальных и серийных имплантатов при эндопротезировании тазобедренного и коленного суставов.

Abstract

One of the pressing issues of modern medicine is the need to improve the results of surgical treatment of patients with stage III osteoarthritis of large joints (according to the classification of N. S. Kosinskaya), as well as with loosening of the components of hip and knee joints through the use of techniques that have high clinical and economic efficiency and including the use of computer modeling and additive 3D printing technologies. Purpose of the study: to conduct a clinical and economic analysis of the effectiveness of using individual and serial components of endoprostheses in the surgical treatment of patients with stage III hip osteoarthritis (according to N. S. Kosinskaya’s classification), as well as with loosening of hip and knee joint implants. Methods: clinical-radiological, computed tomographic, biomechanical, statistical, analytical, sociological. The study included 348 patients who were divided into 10 groups depending on the individual and serial components of implants used in their treatment. Results. The effectiveness of surgical treatment of stage III hip osteoarthritis using individual acetabular implants in primary hip replacement, assessed using QALYs, was 0.79, and the CER (“cost-effectiveness”) indicator was 350,424.7. Moreover, the use of only serial imlants in a similar operation led to a decrease in CER to 262,977.2 and QALY to 0.63. Higher QALYs have also been observed with the use of additive technologies in revision hip arthroplasty. The effectiveness of surgical treatment using individual implants for type IIIa acetabular defect was 0.77 (CER – 341,110), for type IIIb – 0.6 (CER – 496,754.3). When using serial components of a revision hip joint implants for type IIIa acetabular defect, the QALY was 0.4 (CER – 540,462.5), for type IIIb – 0.4 (CER – 653,500.5). The best QALYs (0.15) and CER (1,348,892) were also obtained with the use of individual acetabular implants made of bone cement in hip replacement for periprosthetic infection in comparison with standard spacers (QALY – 0.07; CER – 2,845 801). The effectiveness of surgical treatment of patients with bone defects of type 2B and 3 according to AORI using individual implants during revision knee arthroplasty was 0.83 (CER – 494,236.8), using serial designs – 0.44 (CER – 939,489, 4). Conclusions. The use of individual implants in total replacement in patients with stage III hip osteoarthritis (according to N. S. Kosinskaya’s classification), as well as loosening of hip and knee implants, made it possible to achieve higher rates of effectiveness of surgical treatment in comparison with implantation of only serial structures. The use of additive 3D printing technologies in all cases, except knee joint replacement for bone defects of types 2B and 3 according to AORI, led to increased costs for treating patients. As a result of the clinical and economic analysis, it was revealed that the use of individual implants made using 3D printing in revision hip arthroplasty for IIIa and IIIb defects of the acetabulum, septic loosening of the components of a previously installed implants, as well as in re-replacement of the knee joint in the presence of AORI type 2B and 3 bone defects achieves the best cost-effectiveness ratio (CER) and is “strongly preferable” to implantation of serial constructs only.