Trends in Practice Patterns of Conventional and Computer-assisted Knee Arthroplasty: An Analysis of 570,671 Knee Arthroplasties Between 2010 and 2017

Abstract

Background: Despite advances in computer-assisted knee arthroplasty (CAKA), little is known about the uptake of this technology in recent years. We aimed to explore the utilization trends and practice variation of CAKA from 2010 to 2017 and investigate the predictors of CAKA adoption. Methods: Patients undergoing conventional knee arthroplasty and CAKA were identified from the states of New York and Florida's administrative databases using the International Classification of Diseases version 9 and 10 procedure codes. Quarterly proportions of CAKA were calculated over the study period, and logistic regression was used to estimate predictors of CAKA utilization. Results: Between 2010 and 2017, quarterly proportion of CAKAs increased from 4.89% in 2010Q1 to 9.45% in 2017Q3 in New York and from 4.03% in 2010Q1 to 5.73% in 2017Q3 in Florida. The general CA code was used to code most of the procedures (81%). Being Black (odds ratio [OR]: 0.63, 95% confidence interval [CI], 0.60 to 0.67), Hispanic (OR: 0.45, CI, 0.41 to 0.50), and having Medicaid coverage (OR: 0.46, CI, 0.40 to 0.53) were associated with lower likelihood of receiving CAKA in New York; similar findings were found in Florida. Conclusion: Utilization of CAKA has increased substantially in both New York and Florida from 2010 to 2017; however, with most CAKAs reported using the general code, understanding adoption rates of various modalities was not possible. Black and Hispanic patients and those with Medicaid insurance are least likely to receive this high-precision technology, illustrating the presence of disparities in the adoption of CAKA.

A comparison of utilization and short-term complications of technology-assisted versus conventional total knee arthroplasty

“…Surprisingly, the annual proportion of TKAs performed using technology within the NSQIP database decreased from 2010 to 2018. A recent study found that the utilization of computer-assisted TKA increased from 4.9% to 9.5% in New York and from 4.0% to 5.7% in Florida between the years 2010 and 2017 [ 14 ]. An NIS database analysis found that the proportion of TA-TKA increased steadily from 1.2% in 2005 to 7.0% in 2014 [ 19 ].…”

“…Although TA-TKA has been available for several decades, TA-TKA has not been universally adopted [ 12 ] and accounts for only 5–10% of TKAs performed in the USA [ 13 , 14 ]. This low utilization rate may be attributable to costly capital investment for hospital systems, increased operative times, a significant learning curve alongside training burden, and skepticism from operators who have already achieved quality outcomes utilizing unassisted techniques [ 15 – 17 ].…”

Revisiting Short-term Outcomes of Conventional and Computer-Assisted Total Knee Arthroplasty: A Population-based Study

“…The primary variable of interest was the use of computer-assisted navigation technology. 8 9 10 11 12 13 14 Covariates included age 21 and insurance type, 22 as well as the Charlson Comorbidity Index, which was applied to clinical comorbidity data to calculate a measure of disease burden. 23 - 25 Race/ethnicity was also included as a covariate because of its known effect on patient access and other outcomes.…”

“… 23 - 25 Race/ethnicity was also included as a covariate because of its known effect on patient access and other outcomes. 14 , 26 - 28 Finally, we adjusted for hospital volume, which was defined using quartiles of combined 2-year procedure volume. 29 , 30 Odds ratios (ORs) and their 95% confidence intervals (95% CIs) were estimated and reported, and all P values were two-sided with statistical significance evaluated at an alpha level of <0.05.…”

“…[8][9][10][11][12][13] In a recently published study spanning 2010 to 2017, a modest increase in the adoption of CATKAs was observed, potentially driven by better patient outcomes. 14 To our knowledge, however, the relationship between CATKAs and patient outcomes in the ICD-10 era remains understudied. The primary objective of this study was to compare the rates of postoperative in-hospital complications and 90-day all-cause readmissions for patients having CATKAs and conventional TKAs.…”