Total knee arthroplasty (TKA) can have relatively high transfusion and adverse event rates. However, a study published on June 8, 2017 in Arthroplasty Today reveals that patients who received ConforMIS, Inc. (CIM) customized implants via 3D technology enjoy much lower adverse event rates.
ConforMIS 3D Technology Improves TKA
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The study, “Comparison of adverse events rates and hospital cost between customized individually made implants and standard off-the-shelf implants for total knee arthroplasty,” was led by researchers Steven D. Culler, Ph.D., Greg M. Martin, M.D., and Alyssa Swearingen.
It was commissioned by ConforMIS and patients were treated at one institution by a single surgeon. Surgeries took place from April 1, 2010 – November 11, 2013. Company CEO Mark Augusti says the research “demonstrates the benefits of customized total knee implants technology to patients, surgeons, hospitals and payers…they (the findings) are part of an important and changing conversation about the role of total knee implants in the delivery of better outcomes at lower costs.”
By the Numbers
The 248 patients analyzed were also less likely to be assigned to rehabilitation and other costly post-acute care facilities. Compared to patients who received off-the-shelf implants (OTS), the 248 with a ConforMIS TKA incurred a lower total cost per episode of care and lower follow-up care costs.
At discharge, 3.3% of TKA patients experience adverse events compared to 14.1% of OTS patients according to the findings. Ninety days after discharge, 8.1% of CIM patients report adverse events compared to 18.2% of OTS patients. More CIM patients were discharged in under three days (42.1%) compared to OTS patients (30.3%). Plus, just 4.8% of CIM patients were discharged to a post-acute care or rehabilitation facility compared to 16.4% of OTS patients. Just 2.4% of CIM patients needed a blood transfusion, while 11.6% of OTS patients required the procedure.
Researchers found that the “total average real hospital costs” when comparing CIM to OTS were almost the same, with just a $48 difference. This suggests that CIM patients can get better surgery and hospital outcomes with no added costs. However, follow-up costs with CIM were $1,313 lower on average than OTS and a net savings of $913.87 for “bundle care” including hospitalization, discharge disposition and pre-operative tomography scans.
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Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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