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Total knee arthroplasty: Comparative analysis of outcome, economics, ad compliations in a rural private practice orthopaedic center

1 August 2002


Total knee arthoplasty (TKA) is widely recognized as one of the most successful modem surgical procedures. A theory exists that TKA may be completed with better results, fewer complications, and lower costs at high volume major urban and/or academic orthopaedic centers than at lower volume centers. A prospective observational cohort study (consecutive case series) was performed to test the hypothesis that outcome and cost of TKA as performed at a rural private-practice orthopaedic center equal published outcome and cost data reflective of major urban and/or academic orthopaedic centers. The Knee Society Clinical Rating System and the Medical Outcomes Study Short Form, 36 questions (SF-36) were used pre- and postoperatively to assess knee morbidity and health related quality of life, respectively. An average total hospital charge for primary TKA was then determined for our facility. We discuss at length the comparison of our results for these variables with those from the historical orthopaedic literature.

Fifty-one TKA procedures in forty-five patients were assessed using the above criterion. After TKA, Knee Society function scores increased from 40.1 ± 25.2 (range- 20 to 100) preoperatively, to 79.1 ± 22.0 (range 15 to 100, p=0.0000). The SF-36 Physical Composite Score improved from 30.6 ± 7.6 to 40.4 ± 10.1 (p=0.000). SF-36 component scores for physical functioning (p=0.0000), role physical (p=0.0012), bodily pain (p=0.0000), vitality (p=0.011 ), and social functioning (p=0.001) all increased significantly. There was no significant change in SF-36 Mental Composite Score, nor was there any statistically significant change in the SF-36 component scores for general health, role emotional and mental health . The average total hospital charge for primary TKA at Holy Cross Hospital during the study period was $27430 ± $3102.

In the cohort of patients evaluated, our results in terms of early clinical outcome (Knee Society scoring) and health related quality of life (SF-36) are equal to outcome cited in the historical published literature. Our results in terms of charges fall within the range predicted, but are greater than the majority of the cost data cited from the comparison studies. Our results do not allow us to reject our null hypothesis. While pain relief, knee function recovery, and improvement in health -related quality of life after TKA in this study appear to be in congruence with results from the bulk of orthopaedic literature, our results in prosthesis survivorship and hospital charges are less optimal. Due to the limitations of the present study, more research needs to be performed to better elucidate this subject.


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