Resurfacing the patella in primary total knee arthroplasty may be more cost-effective compared with patellar retention, with higher costs resulting from a higher revision rate for secondary resurfacing in patients who did not undergo patella resurfacing, according to a cost-effectiveness analysis published in The Journal of Arthroplasty.
Using data from the 2014 Australian Registry, researchers used a decision analytic model to conduct a cost-effectiveness analysis representing a hypothetical TKA cohort with or without patellar resurfacing. Researchers used the quality-adjusted life-year (QALY) from published utility scores as the effectiveness outcome, and estimated cost-effectiveness from a Canadian public health care payer perspective. Researchers also valued costs and quality of life in 2015 United States dollars and discounted annually at 5%.
Among 443,948 patients undergoing TKA, results showed 218,033 patients had their patella resurfaced and 225,915 patients did not. During the 14-year study period, researchers noted a total of 5,992 and 9,240 revisions in the resurfaced and unresurfaced groups, respectively. Patients in the unresurfaced group had a mean total treatment cost per patient of $13,296.63 vs. $12,917.01 in the resurfaced group. Researchers also found the resurfaced group had superior quality of life results, with 6.01 QALYs in the resurfaced group compared with 5.37 QALYs in the unresurfaced group. Reduction of the rate of secondary resurfacing procedures to 0.5% or less may yield no difference in cost between the two procedures, according to a results of a one-way sensitivity analysis.
“Although our results suggest that patella resurfacing results in higher [quality of life] QoL and lower costs, further prospective studies that measure QoL following secondary resurfacing revision TKA may add more insight regarding the role of patellar resurfacing in TKA,” the authors wrote. “Future study will provide support to the idea that rather than having a practice of resurfacing all or no patellae, the best method for cost-effectiveness may be selective resurfacing, with appropriate evidence-based selection criteria to be determined with further investigation.” – by Casey Tingle
Disclosures: Weeks reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.