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Metal on metal hip arthroplasty surveillance at a tertiary centre: design, patients’ adherence, and cost analysis

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Abstract

Purpose

Metal-on-metal (MOM) bearings may carry higher than expected revision rates and serious complications: an appropriate surveillance may be advocated. Aims of this paper were to (1) present the biennial experience of MOM surveillance in a tertiary centre, (2) describe the patients’ adherence to monitoring, and (3) analyze the costs of the surveillance

Methods

The design of MOM surveillance was developed according to the guidelines of the Italian Society of Orthopaedics and Traumatology. The adherence to every follow-up was expressed as raw numbers and percentages. A cost analysis (direct and indirect costs) was conducted and projected in a five year time span.

Results

About 61.1% of patients adhered to the first step of the surveillance, and 13.5% answered to a specific questionnaire about MOM implant. About 36.2% of the patients participated for the annual follow-up, and 18.1% entered the six month follow-up program. Of the implants, 2.5% required a revision. A two year surveillance costs €45,520.30, €236,443.98 (57.7%) including revisions. Five-year projected costs will be €23.113,64 (5.6%). Hospital indirect costs, including personnel working days, were €150,392.30 (36.7%). The estimated economic burden for seven years will be €409,949.92 (direct € 259,557.62, indirect €150,392.30).

Conclusion

Patients’ adherence to MOM surveillance is modest and the rate of dropouts seems not to stop over the time. Most of the expenses are due to revision surgeries, as well as indirect costs. Economy of scale may be suggested to reduce the costs, involving as much MOM population as possible.

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Authors and Affiliations

  1. Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy

    Alfredo Dell’Isola & Barbara Bordini

  2. Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d’anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy

    Francesco Castagnini, Maurizio Montalti & Francesco Traina

  3. IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy

    Maurizia Rolli

  4. DIBINEM, University of Bologna, Bologna, Italy

    Francesco Traina

  5. University of Messina, Messina, Italy

    Francesco Traina

Authors
  1. Alfredo Dell’Isola
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  2. Francesco Castagnini
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  3. Barbara Bordini
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  4. Maurizio Montalti
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  5. Maurizia Rolli
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  6. Francesco Traina
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Corresponding author

Correspondence to Francesco Castagnini.

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The authors declare that they have no conflict of interest.

Ethical review committee statement

The local ethical committee approved the study (433/2019/Oss/IOR, 3/7/2019). The study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and in accordance with relevant regulations of the US Health Insurance Portability and Accountability Act (HIPAA).

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Dell’Isola, A., Castagnini, F., Bordini, B. et al. Metal on metal hip arthroplasty surveillance at a tertiary centre: design, patients’ adherence, and cost analysis. International Orthopaedics (SICOT) 44, 1943–1949 (2020). https://doi.org/10.1007/s00264-020-04618-6

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  • DOI: https://doi.org/10.1007/s00264-020-04618-6

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