Skip to main content

Advertisement

SpringerLink
Log in

Marginal contribution of UKS- versus TKA in varus arthritis of the knee

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

In recent years, decisions regarding the treatment of individual patients have increasingly been affected by economic considerations. The G-DRG system reimburses sledge endoprosthetic implantations at a much lower rate than surface replacements and at significantly different cost weights (CW). Therefore, when only G-DRG payments are considered, TKA produces higher gains. Taking only these revenues alone into consideration, however, does not provide the basis of an economically sound decision-making process. The target of this research was to present a comparison between variable costs of the two procedures.

Methods

The mean cost and performance data of 28 Endo-Modell (Link company) sledge implantations (UKS) and of 85 NexGen CR surface replacement total knee arthroplasties (TKA; Zimmer company) were compared in 2007.

Results

From the perspective of the hospital, UKS treatment is of greater economic advantage when the medical indication is given. In preferring UKS marginal contribution can be improved, and although the relative weighting is comparatively low, the costs are significantly lower than in a comparative analysis of TKA. Based on the length of stay required for each procedure the average daily CW for UKS can be calculated as 0.1728, while being 0.1955 for TKA. The earlier release of the first patient results in another patient being admitted 1.5 days earlier and thus an increase in case mix. Meanwhile, the case-mix index and the costs of care per case decrease ceteris paribus.

Conclusion

Assuming the correct medical indication, the hospital seeking to maximize its marginal contribution would be wise to select sledge endoprosthesis implantation. Considering the economic perspective of gains and costs, the assumption that TKA is advantageous could not be confirmed in the present study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Flessa S (2007) Grundzüge der Krankenhausbetriebslehre, vol 1. Oldenbourg Wissenschaftsverlag, München

    Book  Google Scholar 

  2. Keun F, Prott R (2008) Einführung in die Krankenhaus-Kostenrechnung, vol 7. Gabler Verlag, Wiesbaden

    Google Scholar 

  3. Töpfer A (2006) Konzepte zur Kostenanalyse und Kostensteuerung. In: Albrecht DM, Töpfer A (eds) Erfolgreiches changemanagement im krankenhaus. Springer, Berlin, pp 71–86

    Chapter  Google Scholar 

  4. Kilger W, Pampel JR, Vikas K (2007) Flexible Plankostenrechnung und Deckungsbeitragsrechnung, vol 12, 12 edn. Gabler Verlag, Wiesbaden

  5. Flessa S (2008) Grundzüge der Krankenhaussteuerung, vol 1. Oldenbourg Wissenschafts verlag, München

  6. Schirmer H (2006) Krankenhaus-controlling: handlungsempfehlungen für krankenhausmanager und krankenhaus controller, vol 3. Expert, Berlin

    Google Scholar 

  7. Stukenborg-Colsman C, Wirth CJ, Lazovic D, Wefer A (2001) High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 7–10-year follow-up prospective randomised study. Knee 8(3):187–194

    Article  PubMed  CAS  Google Scholar 

  8. Dalury DF, Fisher DA, Adams MJ, Gonzales RA (2009) Unicompartmental knee arthroplasty compares favorably to total knee arthroplasty in the same patient. Orthopedics 32(4):253–256

    Google Scholar 

  9. Kankovsky V, Ptacek Z, Kubat P (2004) Long-term results of unicompartmental knee joint replacement. Acta Chir Orthop Traumatol Cech 71(2):84–92

    PubMed  CAS  Google Scholar 

  10. Padgett DE, Stern SH, Insall JN (1991) Revision total knee arthroplasty for failed unicompartmental replacement. J Bone Joint Surg Am 73(2):186–190

    PubMed  CAS  Google Scholar 

  11. Lombardi AV Jr, Berend KR, Walter CA, Aziz-Jacobo J, Cheney NA (2009) Is recovery faster for mobile-bearing unicompartmental than total knee arthroplasty? Clin Orthop Relat Res 467(6):1450–1457

    Article  PubMed  Google Scholar 

  12. Willis-Owen CA, Brust K, Alsop H, Miraldo M, Cobb JP (2009) Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Knee 16(6):473–478. doi:10.1016/j.knee.2009.04.006

    Article  PubMed  Google Scholar 

  13. Callaghan JJ (2005) Unicompartmental knee replacement: introduction—where have we been? Where are we now? Where are we going? Clin Orthop Relat Res 430:272–273

    Article  PubMed  Google Scholar 

  14. Carr A, Keyes G, Miller R, O’Connor J, Goodfellow J (1993) Medial unicompartmental arthroplasty. A survival study of the Oxford meniscal knee. Clin Orthop Relat Res 295(295):205–213

    PubMed  Google Scholar 

  15. Ritter MA, Faris PM, Thong AE, Davis KE, Meding JB, Berend ME (2004) Intra-operative findings in varus osteoarthritis of the knee. An analysis of pre-operative alignment in potential candidates for unicompartmental arthroplasty. J Bone Joint Surg Br 86(1):43–47

    PubMed  CAS  Google Scholar 

  16. Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, Kehlet H (2010) What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark. Arch Orthop Trauma Surg 130(2):263–268

    Article  PubMed  Google Scholar 

  17. Kehlet H, Soballe K (2010) Fast-track hip and knee replacement—what are the issues? Acta Orthop 81(3):271–272

    Article  PubMed  Google Scholar 

  18. Robertsson O, Borgquist L, Knutson K, Lewold S, Lidgren L (1999) Use of unicompartmental instead of tricompartmental prostheses for unicompartmental arthrosis in the knee is a cost-effective alternative. 15,437 primary tricompartmental prosthesis were compared with 10,624 primary medial or lateral unicompartmental prosthesis. Acta Orthop Scand 70(2):170–175

    Article  PubMed  CAS  Google Scholar 

  19. Soohoo NF, Sharifi H, Kominski G, Lieberman JR (2006) Cost-effectiveness analysis of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty for unicompartmental osteoarthritis. J Bone Joint Surg Am 88(9):1975–1982

    Article  PubMed  Google Scholar 

  20. Slover J, Espehaug B, Havelin LI, Engesaeter LB, Furnes O, Tomek I, Tosteson A (2006) Cost-effectiveness of unicompartmental and total knee arthroplasty in elderly low-demand patients. A Markov decision analysis. J Bone Joint Surg Am 88(11):2348–2355

    Article  PubMed  Google Scholar 

  21. Lakstein D (2009) Unicompartmental knee arthroplasty. Isr Med Assoc J 11(9):578 author reply 578

    PubMed  CAS  Google Scholar 

  22. Jamali AA, Scott RD, Rubash HE, Freiberg AA (2009) Unicompartmental knee arthroplasty: past, present, and future. Am J Orthop (Belle Mead NJ) 38(1):17–23

    Google Scholar 

  23. Zhang QD, Guo WS, Liu ZH, Zhang Q, Cheng LM, Li ZR (2009) Meta-analysis of unicompartmental knee arthroplasty versus high tibial osteotomy in the treatment of unicompartmental knee osteoarthritis. Zhonghua Yi Xue Za Zhi 89(39):2768–2772

    PubMed  Google Scholar 

  24. Hollnecker J, Kluwe C, Wedemeyer S, Gemmel J (2008) Pfadcontrolling softwaregestütztes controlling klinischer behandlungspfade. das Krankenhaus 12:1353–1356

    Google Scholar 

  25. InEK-GmbH (2007) G-DRG-Fallpauschalen-Katalog 2007 http://www.g-drg.de/cms/index.php/Archiv/Systemjahr_2007_bzw._Datenjahr_2005#sm2. Accessed 21 Oct 2011

  26. Biau D, Mullins MM, Judet T, Piriou P (2006) Is anyone too old for a total knee replacement? Clin Orthop Relat Res 448:180–184

    PubMed  CAS  Google Scholar 

  27. Hilton AI, Back DL, Espag MP, Briggs TW, Cannon SR (2004) The octogenarian total knee arthroplasty. Orthopedics 27(1):37–39

    PubMed  Google Scholar 

  28. Zicat B, Rorabeck CH, Bourne RB, Devane PA, Nott L (1993) Total knee arthroplasty in the octogenarian. J Arthroplasty 8(4):395–400

    Article  PubMed  CAS  Google Scholar 

  29. Macario A, Schilling P, Rubio R, Goodman S (2003) Economics of one-stage versus two-stage bilateral total knee arthroplasties. Clin Orthop Relat Res 414:149–156

    Article  PubMed  Google Scholar 

  30. Buckup K (2004) Die unikondyläre schlitten prothesis: pros und contra, vol 1. Steinkopff, Darmstadt

    Book  Google Scholar 

  31. Siebers L, Helling J, Fiori W, Bunzemeier H, Roeder N (2008) Krankenhausinterne DRG-erlösverteilung auf der basis der InEK-daten: möglichkeiten und grenzen. das Krankenhaus 01(1):35–44

    Google Scholar 

  32. Rochell B, Roeder N (2003) DRG–das neue krankenhausvergütungssystem für Deutschland. Der Urologe A 42(4):471–484

    CAS  Google Scholar 

  33. Schneider M, Kawahara I, Ballantyne G, McAuley C, Macgregor K, Garvie R, McKenzie A, Macdonald D, Breusch SJ (2009) Predictive factors influencing fast track rehabilitation following primary total hip and knee arthroplasty. Arch Orthop Trauma Surg 129(12):1585–1591

    Article  PubMed  Google Scholar 

  34. InEK-GmbH (2011) G-DRG-fallpauschalen-katalog 2011 http://www.g-drg.de/cms/index.php/G-DRG-System_2011/Fallpauschalen-Katalog/Fallpauschalen-Katalog_2011. Accessed 22 Oct 2011

  35. InEK-GmbH (2012) G-DRG-fallpauschalen-katalog 2012. http://www.g-drg.de/cms/G-DRG-System_2012/Fallpauschalen-Katalog/Fallpauschalen-Katalog_2012. Accessed 11 Apr 2012

  36. Lavernia CJ, Sierra RJ, Hernandez RA (2000) The cost of teaching total knee arthroplasty surgery to orthopaedic surgery residents. Clin Orthop Relat Res 380:99–107

    Article  PubMed  Google Scholar 

  37. Rehart S, Schwinnen I, Rittmeister M, Kerschbaumer F (2002) A comparison of total knee replacement in patients with rheumatoid arthritis and those with degenerative arthritis. Orthopade 31(12):1179–1186

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors report that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany

    Richard Kasch, Sebastian Merk, Ralph Kayser, Andreas Lahm & Harry Merk

  2. Department of Orthopedic and Trauma Surgery, RWTH Aachen University, Aachen, Germany

    Wolf Drescher

  3. Department of Orthopedic and Trauma Surgery, University Hospital Schleswig–Holstein, Campus Lübeck, Lübeck, Germany

    Arndt Peter Schulz

  4. Department of Orthopedic Surgery, University Medical Center of Rostock, Doberaner Str. 142, 18057, Rostock, Germany

    Ralf Skripitz & Susanne Fröhlich

  5. Municipal Clinic Munich Bogenhausen, University Hospital, Munich, Germany

    Andreas Lahm

  6. Health Care Management, Faculty of Law and Economics, Ernst-Moritz-Arndt-University, Greifswald, Germany

    Steffen Fleßa

Authors
  1. Richard Kasch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sebastian Merk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wolf Drescher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arndt Peter Schulz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ralph Kayser
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ralf Skripitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Susanne Fröhlich
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andreas Lahm
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Harry Merk
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Steffen Fleßa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard Kasch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kasch, R., Merk, S., Drescher, W. et al. Marginal contribution of UKS- versus TKA in varus arthritis of the knee. Arch Orthop Trauma Surg 132, 1165–1172 (2012). https://doi.org/10.1007/s00402-012-1535-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-012-1535-2

Keywords

Search

Navigation