CT planning studies for robotic total knee arthroplasty

Abstract

Aims The aim of this study was to analyze the true costs associated with preoperative CT scans performed for robotic-assisted total knee arthroplasty (RATKA) planning and to determine the value of a formal radiologist’s report of these studies. Methods We reviewed 194 CT reports of 176 sequential patients who underwent primary RATKA by a single surgeon at a suburban teaching hospital. CT radiology reports were reviewed for the presence of incidental findings that might change the management of the patient. Payments for the scans, including the technical and professional components, for 330 patients at two hospitals were also recorded and compared. Results There were 82 incidental findings in 61 CT studies, one of which led to a recommendation for additional testing. Across both institutions, the mean total payment for a preoperative scan was $446 ($8 to $3,870). The mean patient payment was $71 ($0 to $2,690). There was wide variation in payments between the institutions. In Institution A, the mean total payment was $258 ($168 to $264), with a mean patient payment of $57 ($0 to $100). The mean technical payment in this institution was $211 ($8 to $856), while the mean professional payment was $48 ($0 to $66). In Institution B, the mean total payment was $636 ($37 to $3,870), with a mean patient payment of $85 ($0 to $2,690). Conclusion The total cost of a CT scan is low and a minimal part of the overall cost of the RATKA. No incidental findings identified on imaging led to a change in management, suggesting that the professional component could be eliminated to reduce costs. Further studies need to take into account the patient perspective and the wide variation in total costs and patient payments across institutions and insurances. Cite this article: Bone Joint J 2020;102-B(6 Supple A):79–84.

Incidental findings detected on preoperative CT imaging obtained for robotic-assisted joint replacements: clinical importance and the effect on the scheduled arthroplasty

“…However, in our experience, these studies are often viewed as a formality only, rather than for diagnostic purposes, used solely for the purposes of surgical planning with little attention given to the actual findings by the radiologist or the surgeon. Furthermore, Abdelfadeel and colleagues, in their study of 176 patients, found no incidental findings that resulted in a change in management [52]. They also suggested that the radiologist professional component and therefore the evaluation of these studies by a trained imaging specialist could be eliminated to help reduce costs, although they themselves report that the professional fee is only approximately 10% of the overall CT examination total cost.…”

Incidental findings on CT scans for robot‐assisted total joint arthroplasty

“…In addition, there has been recent debate whether formal professional interpretation by a radiologist for these operation-planning scans is worth the associated cost. 16 We found that there may not be additional benefit to the patient's health when imaging for robotic-arm arthroplasty beyond mere preoperative planning.…”

“…Abdelfadeel et al found that of 346 patients who received preoperative CT for robotic-assisted TKA, it was not cost-effective to include professional readings of the reports since the radiologist report did not change patient management. 16 However, orthopaedic surgeons are not as likely to notice incidental findings, as they are only analysing the specific area of focus. In the present study, one patient had a lipoma excision and another underwent lithotripsy.…”

The Use of Computerized Tomography Scans in Elective Knee and Hip Arthroplasty—What Do They Tell Us and at What Risk?

“…In a review of CT scans performed for primary robot-assisted TKA, Abdelfadeel et al. found that the mean total payment for a preoperative scan was $446, but there was wide variation based on location, negotiated contracts, and other geographical variations [ 42 ]. Another cost that should not be overlooked is the potential unnecessary costs accrued to investigate incidental, and typically unimportant, findings found on CT scans [ 42 ].…”

“…found that the mean total payment for a preoperative scan was $446, but there was wide variation based on location, negotiated contracts, and other geographical variations [ 42 ]. Another cost that should not be overlooked is the potential unnecessary costs accrued to investigate incidental, and typically unimportant, findings found on CT scans [ 42 ]. Furthermore, the cost of radiation-induced illness is not well considered at this time.…”