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Economic analyses of fast-track total hip and knee arthroplasty: a systematic review

  • General Review • HIP - ARTHROPLASTY
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The number of total hip (THA) and knee arthroplasties (TKA) grows constantly which causes enormously rising costs for healthcare systems. The aim of this systematic literature review was to evaluate whether a cost reduction can be achieved by THA or TKA fast-track protocols, which is a multidisciplinary approach aiming at faster recovery.

Methods

A systematic literature research was undertaken for the timeframe from 2007/01/01 to 2019/03/04 in PubMed. Abstracts and title of the identified records were checked for eligible criteria and afterward the full text was assessed.

Results

Seven studies were included in the review. All studies showed a reduction in the total cost for fast-track THA and TKA. Most studies based their cost calculations on the amount of days the patients spend in the hospital.

Conclusion

Using a fast-track protocol can significantly reduce the overall costs of the treatment.

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References

  1. Turnbull ZA, Sastow D, Giambrone GP, Tedore T (2017) Anesthesia for the patient undergoing total knee replacement: current status and future prospects. Local Reg Anesth 10:1–7

    Article  CAS  Google Scholar 

  2. Vogel LA, Carotenuto G, Basti JJ, Levine WN (2011) Physical activity after total joint arthroplasty. Sports Health 3:441–450

    Article  Google Scholar 

  3. Kauppila A-M, Sintonen H, Aronen P, Ohtonen P, Kyllönen E, Arokoski JPA (2011) Economic evaluation of multidisciplinary rehabilitation after primary total knee arthroplasty based on a randomized controlled trial. Arthritis Care Res 63:335–341

    Google Scholar 

  4. Harris WH, Sledge CB (1990) Total hip and total knee replacement. N Engl J Med 323:725–731

    Article  CAS  Google Scholar 

  5. Quack V, Ippendorf AV, Betsch M, Schenker H, Nebelung S, Rath B et al (2015) Multidisziplinäre Rehabilitation und multimodale Fast-Track-Rehabilitation in der Knieendoprothetik: schneller, besser, günstiger? Eine Umfrage und systematische Literaturrecherche. Die Rehabilit 54:245–251

    Article  CAS  Google Scholar 

  6. Karlson EW, Mandl LA, Aweh GN, Sangha O, Liang MH, Grodstein F (2003) Total hip replacement due to osteoarthritis: the importance of age, obesity, and other modifiable risk factors. Am J Med 114:93–98

    Article  Google Scholar 

  7. Galbraith AS, McGloughlin E, Cashman J (2018) Enhanced recovery protocols in total joint arthroplasty: a review of the literature and their implementation. Irish J Med Sci 187(1):97–109

    Article  CAS  Google Scholar 

  8. Bitton R (2009) The economic burden of osteoarthritis. Am J Manag Care 15:S230–S235

    PubMed  Google Scholar 

  9. Lavernia CJ, Villa JM (2015) Rapid recovery programs in arthroplasty: the money side. J Arthroplast 30:533–534

    Article  Google Scholar 

  10. Paxton EW, Inacio M, Slipchenko T, Fithian DC (2008) The Kaiser Permanente national total joint replacement registry. Perm J 12:12–16

    Article  Google Scholar 

  11. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am Vol 89:780–785

    Article  Google Scholar 

  12. Bleß H-H, Kip M (2017) Weißbuch Gelenkersatz: Versorgungssituation endoprothetischer Hüft- und Knieoperationen in Deutschland. Springer, Berlin

    Book  Google Scholar 

  13. Jørgensen CC, Kehlet H (2013) Fall-related admissions after fast-track total hip and knee arthroplasty—cause of concern or consequence of success? Clin Interv Aging 8:1569–1577

    Article  Google Scholar 

  14. Pamilo KJ, Torkki P, Peltola M, Pesola M, Remes V, Paloneva J (2018) Reduced length of uninterrupted institutional stay after implementing a fast-track protocol for primary total hip replacement. Acta Orthop 89(1):10–16

    Article  Google Scholar 

  15. Sarin A, Litonius ES, Naidu R, Yost CS, Varma MG, Chen L-L (2016) Successful implementation of an enhanced recovery after surgery program shortens length of stay and improves postoperative pain, and bowel and bladder function after colorectal surgery. BMC Anesthesiol 16:55

    Article  Google Scholar 

  16. Kehlet H (2013) Fast-track hip and knee arthroplasty. Lancet 381:1600–1602

    Article  Google Scholar 

  17. Nanavati AJ, Prabhakar S (2014) Fast-track surgery: toward comprehensive peri-operative care. Anesthesia Essays Res 8:127–133

    Article  Google Scholar 

  18. Glassou EN, Pedersen AB, Hansen TB (2014) Risk of re-admission, reoperation, and mortality within 90 days of total hip and knee arthroplasty in fast-track departments in Denmark from 2005 to 2011. Acta Orthop 85(5):493–500

    Article  Google Scholar 

  19. Larsen K, Sørensen OG, Hansen TB, Thomsen PB, Søballe K (2008) Accelerated perioperative care and rehabilitation intervention for hip and knee replacement is effective: a randomized clinical trial involving 87 patients with 3 months of follow-up. Acta Orthop 79:149–159

    Article  Google Scholar 

  20. Kehlet H (2008) Fast-track colorectal surgery. Lancet 371:791–793

    Article  Google Scholar 

  21. Klapwijk LCM, Mathijssen NMC, van Egmond JC, Verbeek BM, Vehmeijer SBW (2017) The first 6 weeks of recovery after primary total hip arthroplasty with fast track. Acta Orthop 88:140–144

    Article  Google Scholar 

  22. Pamilo KJ, Torkki P, Peltola M, Pesola M, Remes V, Paloneva J (2018) Fast-tracking for total knee replacement reduces use of institutional care without compromising quality. Acta Orthopaedica 89(2):184–189

    Article  Google Scholar 

  23. Seeber GH, Wijnen A, Lazovic D, Bulstra SK, Dietz G, van Lingen CP et al (2017) Effectiveness of rehabilitation after a total hip arthroplasty: a protocol for an observational study for the comparison of usual care in the Netherlands versus Germany. BMJ Open 7:e016020

    Article  Google Scholar 

  24. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097

    Article  Google Scholar 

  25. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928 (clinical research ed)

    Article  Google Scholar 

  26. Andreasen SE, Holm HB, Jørgensen M, Gromov K, Kjærsgaard-Andersen P, Husted H (2017) Time-driven activity-based cost of fast-track total hip and knee arthroplasty. J Arthroplast 32:1747–1755

    Article  Google Scholar 

  27. Khan SK, Malviya A, Muller SD, Carluke I, Partington PF, Emmerson KP et al (2014) Reduced short-term complications and mortality following enhanced recovery primary hip and knee arthroplasty: results from 6,000 consecutive procedures. Acta Orthop 85:26–31

    Article  Google Scholar 

  28. Larsen K, Hansen TB, Thomsen PB, Christiansen T, Søballe K (2009) Cost-effectiveness of accelerated perioperative care and rehabilitation after total hip and knee arthroplasty. J Bone Joint Surg Am vol 91:761–772

    Article  Google Scholar 

  29. Wilches C, Sulbarána JD, Fernándeza JE, Gisberta JM, Bausili JM, Pelfort X (2017) Fast-track recovery technique applied to primary total hip and knee replacement surgery. Analysis of costs and complications. Rev Esp Cir Ortop Traumatol 61:111–116

    CAS  PubMed  Google Scholar 

  30. Lieb E, Hanstein T, Schuerings M, Trampuz A, Perka C (2015) Eine Verkürzung der Behandlungsdauer von periprothetischen Infektionen durch ein Fast-Track-Konzept ist ökonomisch unmöglich. Z Orthop Unfallchir 153:618–623

    Article  CAS  Google Scholar 

  31. Köksal İ, Tahta M, Şimşek ME, Doğan M, Bozkurt M (2015) Efficacy of rapid recovery protocol for total knee arthroplasty: a retrospective study. Acta Orthop Traumatol Turcica 49:382–386

    Google Scholar 

  32. Akhavan S, Ward L, Bozic KJ (2016) Time-driven activity-based costing more accurately reflects costs in arthroplasty surgery. Clin Orthop Relat Res 474:8–15

    Article  Google Scholar 

  33. Chen A, Sabharwal S, Akhtar K, Makaram N, Gupte CM (2015) Time-driven activity based costing of total knee replacement surgery at a London teaching hospital. Knee 22:640–645

    Article  Google Scholar 

  34. Kirksey M, Chiu YL, Ma Y, Della Valle AG, Poultsides L, Gerner P et al (2012) Trends in in-hospital major morbidity and mortality after total joint arthroplasty: United States 1998–2008. Anesth Analg 115:321–327

    Article  Google Scholar 

  35. Yanik JM, Bedard NA, Hanley JM, Otero JE, Callaghan JJ, Marsh JL (2018) Rapid recovery total joint arthroplasty is safe, efficient, and cost-effective in the veterans administration setting. J Arthroplast 33:3138–3142

    Article  Google Scholar 

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Funding

This study did not receive any funding or grants.

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Authors and Affiliations

  1. Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI), University Medical Center Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany

    Matthias Büttner, Anica M. Mayer, Britta Büchler & Singer Susanne

  2. Institute of Physical Therapy, Prevention and Rehabilitation, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany

    Ulrich Betz

  3. Center for Orthopedics and Trauma Surgery, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany

    Philipp Drees

Authors
  1. Matthias Büttner
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  2. Anica M. Mayer
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  3. Britta Büchler
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  4. Ulrich Betz
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  5. Philipp Drees
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  6. Singer Susanne
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Contributions

All authors contributed to the conception and design of the study. All authors participated in critically revising the manuscript and all authors’ approved the final version of the manuscript for submission. Anica Mayer and Matthias Büttner performed the literature search. Anica Mayer and Matthias Büttner interpreted the data and drafted the manuscript. Anica Mayer and Britta Büchler performed the quality assessment of the studies.

Corresponding author

Correspondence to Matthias Büttner.

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Conflict of interest

The authors declare that they have no conflict of interest.

Human and animals rights

No research involving human participants and/or animals was carried out.

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No informed consent was obtained, due to the nature of the study being a systematic review.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Büttner, M., Mayer, A.M., Büchler, B. et al. Economic analyses of fast-track total hip and knee arthroplasty: a systematic review. Eur J Orthop Surg Traumatol 30, 67–74 (2020). https://doi.org/10.1007/s00590-019-02540-1

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  • DOI: https://doi.org/10.1007/s00590-019-02540-1

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