These authors point out that numerous joint arthroplasty implant options of varying cost are available to the surgeon, but it is unclear whether more costly implants add value in terms of function or longevity.
They evaluated registry survival of higher-cost “premium” knee and hip components compared to lower priced standard components.
Premium TKA components were defined as mobile-bearing designs, high-flexion designs, oxidized zirconium designs, those including moderately crosslinked polyethylene inserts, or some combination.
Premium THAs included ceramic-on-ceramic, metal-on-metal, and ceramic-on-highly crosslinked
polyethylene designs.
They compared 3462 standard TKAs to 2806 premium TKAs and 868 standard THAs to 1311 premium THAs from the HealthEast Joint Registry (HEJR), a community-based total joint registry in the St Paul, MN, metropolitan area. More than 40 community surgeons operating at five hospitals contributed complete registry data on all total joint operations performed, none of whom is an implant designer developer or industry consultant.
The cost of the premium implants was on average approximately $1000 higher than the standard
implants. There was no significant difference in the cumulative revision rate at 7–8 years between premium and standard TKAs or THAs.
This study is limited by not including clinical outcome data. However, these data challenge the advocates of premium implants to demonstrate superior comfort and function for patients receiving the premium arthroplasty in order to justify the increase in cost.
As the authors state, "All innovation does not represent improvement, and higher cost does not necessarily equate to higher quality"
See the related post "Considering new technologies for our practice - understanding bias"
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