Abstract
Clinical trials examining the effect of total knee arthroplasty (TKA) implant design on clinical, functional, and utilization outcomes have yielded conflicting Results: Our objective was to evaluate the effect of single-radius (SR) vs. multi-radius (MR) implant design on those outcomes for TKA patients in the real-world setting. Clinical data collected over a 4-year period from a large medical institution in the OMNY Medical Device Database was used to identify patient encounters where unilateral TKA was performed. A representative implant system was chosen for SR and MR implant designs, and patients were grouped into respective cohorts. Point estimates and measures of variability were generated for clinical (mortality, postoperative knee pain, postoperative implant removal), functional (non-routine discharge disposition), and utilization outcomes (gross charges [$]; length of stay [LOS]). We divided 1464 patients into SR (N=1135) and MR (N=329) cohorts. Distributions of age, gender, race, and employment status were similar between cohorts. Clinical and functional outcomes were similar between SR and MR cohorts: mortality (% [95% confidence interval]: 1.1% [0.6% - 2.0%] vs 0.3% [0.0% - 2.0%]), postoperative knee pain (0.6% [0.2% - 1.3%] vs 1.2% [0.4% - 3.3%]), postoperative implant removal (0.4% [0.2% - 1.1%] vs 0.0% [0.0% - 1.4%]), non-routine discharge disposition (16.4% [14.3% - 18.7%] vs 16.4% [12.7% - 21.0%]). Utilization was similar between SR and MR cohorts for LOS (mean [SD]: 0.98 [1.38] vs 0.96 [1.53]), while gross charges were slightly higher for the SR cohort (median [Q1, Q3]: $43,879 [$39,392 - $51,851] vs. $39,255 [$35,778 - $42,599]). Clinical and functional outcomes were similar for patients undergoing TKA using two popular knee implant designs; the SR cohort incurred slightly higher charges than the MR cohort, but this may be specific to the chosen systems. Further research is needed to determine drivers of cost differences and to better characterize outcomes in patients undergoing TKA.
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