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Der Orthopäde

, 38:1235 | Cite as

Kostenanalyse zur Navigation in der Knieendoprothetik

  • O. CerhaEmail author
  • S. Kirschner
  • K.-P. Günther
  • J. Lützner
Originalien

Zusammenfassung

Hintergrund

Die Implantation von Knietotalendoprothesen (Knie-TEP) gehört zu den häufigsten Operationen in der Orthopädie und Unfallchirurgie. Der Erfolg hängt neben patientenassoziierten Faktoren und einem suffizienten Weichteilbalancing wesentlich von der korrekten Ausrichtung der Komponenten ab. Ein Instrument zur Verbesserung der Implantationsgenauigkeit stellt die computerassistierte Navigation dar, deren höhere Präzision in Bezug auf die Beinachse belegt ist. Dieses Verfahren ist in Europa und Nordamerika etabliert. Im deutschen DRG-System werden die damit verbundenen Aufwendungen bisher nicht vergütet. Ziel der Untersuchung ist deshalb eine Analyse der Kosten bei Implantation einer Knie-TEP mittels computerassistierter Navigation gegenüber der konventionellen Technik.

Methodik

Es wurden die Anschaffungskosten verschiedener Navigationssysteme (Abschreibungsmodelle über 5 und 10 Jahre), die jährlichen Kosten für Wartung und Software-Updates sowie die pro Operation anfallenden Kosten (Verbrauchsmaterial, Verlängerung der Operationszeit) berücksichtigt. Die zusätzliche Operationszeit wurde anhand einer Metaanalyse der aktuellen Literatur ermittelt. Es wurden Modellsituationen mit 25, 50, 100, 200 und 500 navigierten Knie-TEP/Jahr berechnet.

Ergebnisse

Die Höhe der finanziellen Mehrbelastung durch die computerassistierte Navigation hängt hauptsächlich vom jährlichen Operationsvolumen und der Verlängerung der Operationszeit ab. Eine relevante Verringerung der zusätzlich entstehenden Kosten zeigte sich in den verschiedenen Modellsituationen zwischen 50 und 100 Operationen/Jahr. Bei 100 navigierten Knie-TEP/Jahr, einer zusätzlichen Operationszeit von 14 min und Abschreibung der Investitionskosten über 10 Jahre betragen die Zusatzkosten je nach Navigationssystem von 300–395 €/Operation.

Schlussfolgerung

Die computerassistierte Navigation bei Knietotalendoprothesen ist mit Zusatzkosten verbunden. Unter ökonomischen Gesichtspunkten erscheint eine Anzahl von >50 navigierten Knie-TEP/Jahr sinnvoll. Die Kosteneffektivität kann erst abgeschätzt werden, wenn Langzeitergebnisse eine tatsächliche Reduktion der Revisionen oder ein verbessertes klinisches Ergebnis zeigen.

Schlüsselwörter

Knietotalendoprothesen Computerassistierte Navigation DRG-System Kostenanalyse Zusatzkosten 

Cost analysis for navigation in knee endoprosthetics

Abstract

Background

Total knee arthroplasty (TKA) is one of the most frequent procedures in orthopaedic surgery. The outcome depends on a range of factors including alignment of the leg and the positioning of the implant in addition to patient-associated factors. Computer-assisted navigation systems can improve the restoration of a neutral leg alignment. This procedure has been established especially in Europe and North America. The additional expenses are not reimbursed in the German DRG system (Diagnosis Related Groups). In the present study a cost analysis of computer-assisted TKA compared to the conventional technique was performed.

Methods

The acquisition expenses of various navigation systems (5 and 10year depreciation), annual costs for maintenance and software updates as well as the accompanying costs per operation (consumables, additional operating time) were considered. The additional operating time was determined on the basis of a meta-analysis according to the current literature. Situations with 25, 50, 100, 200 and 500 computer-assisted TKAs per year were simulated.

Results

The amount of the incremental costs of the computer-assisted TKA depends mainly on the annual volume and the additional operating time. A relevant decrease of the incremental costs was detected between 50 and 100 procedures per year. In a model with 100 computer-assisted TKAs per year an additional operating time of 14 mins and a 10 year depreciation of the investment costs, the incremental expenses amount to € 300-395 depending on the navigation system.

Conclusions

Computer-assisted TKA is associated with additional costs. From an economical point of view an amount of more than 50 procedures per year appears to be favourable. The cost-effectiveness could be estimated if long-term results will show a reduction of revisions or a better clinical outcome.

Keywords

Total knee arthroplasty Computer-assisted navigation Diagnosis-related groups Cost analysis Additional costs 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Bathis H, Shafizadeh S, Paffrath T et al (2006) Are computer assisted total knee replacements more accurately placed? A meta-analysis of comparative studies. Orthopade 35(10):1056–1065CrossRefPubMedGoogle Scholar
  2. 2.
    Bauwens K, Matthes G, Wich M et al (2007) Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 89(2):261–269CrossRefPubMedGoogle Scholar
  3. 3.
    Berend ME, Ritter MA, Meding JB et al (2004) Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res (428):26–34CrossRefGoogle Scholar
  4. 4.
    BQS (2007) BQS-Qualitätsreport 2007. BQS, Düsseldorf, http://www.bqs-outcome.de/2007Google Scholar
  5. 5.
    Chauhan SK, Scott RG, Breidahl W, Beaver RJ (2004) Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. J Bone Joint Surg Br 86(3):372–377CrossRefPubMedGoogle Scholar
  6. 6.
    Church JS, Scadden JE, Gupta RR et al (2007) Embolic phenomena during computer-assisted and conventional total knee replacement. J Bone Joint Surg Br 89(4):481–485CrossRefPubMedGoogle Scholar
  7. 7.
    Carl Gustav Carus Universitätsklinikum (2008) Controlling. Universitätsklinikum Carl Gustav Carus, DresdenGoogle Scholar
  8. 8.
    Decking R, Markmann Y, Fuchs J et al (2005) Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty 20(3):282–288CrossRefPubMedGoogle Scholar
  9. 9.
    Ensini A, Catani F, Leardini A et al (2007) Alignments and clinical results in conventional and navigated total knee arthroplasty. Clin Orthop Relat Res 457:156–162PubMedGoogle Scholar
  10. 10.
    Friederich N, Verdonk R (2008) The use of computer-assisted orthopedic surgery for total knee replacement in daily practice: a survey among ESSKA/SGO-SSO members. Knee Surg Sports Traumatol Arthrosc 16(6):536–543CrossRefPubMedGoogle Scholar
  11. 11.
    Hofmann S, Romero J, Roth-Schiffl E, Albrecht T (2003) Rotational malalignment of the components may cause chronic pain or early failure in total knee arthroplasty. Orthopade 32(6):469–476PubMedGoogle Scholar
  12. 12.
    Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73(5):709–714PubMedGoogle Scholar
  13. 13.
    Jenny JY, Miehlke RK, Giurea A (2008) Learning curve in navigated total knee replacement. A multi-centre study comparing experienced and beginner centres. Knee 15(2):80–84PubMedGoogle Scholar
  14. 14.
    Jerosch J, Fuchs S, Heisel J (1997) Knieendoprothetik – eine Standortbestimmung. Dtsch Arztebl 94(8):A-449/B-361/C-339Google Scholar
  15. 15.
    Kessler O, Lacatusu E, Sommers MB et al (2006) Malrotation in total knee arthroplasty: Effect on tibial cortex strain captured by laser-based strain acquisition. Clin Biomech 21(6):603–609CrossRefGoogle Scholar
  16. 16.
    Kim SJ, MacDonald M, Hernandez J, Wixson RL (2005) Computer assisted navigation in total knee arthroplasty: improved coronal alignment. J Arthroplasty 20(7 Suppl 3):123–131CrossRefPubMedGoogle Scholar
  17. 17.
    Kim YH, Kim JS, Yoon SH (2007) Alignment and orientation of the components in total knee replacement with and without navigation support: a prospective, randomised study. J Bone Joint Surg Br 89(4):471–476CrossRefPubMedGoogle Scholar
  18. 18.
    Krackow KA, Bayers-Thering M, Phillips MJ, Mihalko WM (1999) A new technique for determining proper mechanical axis alignment during total knee arthroplasty: progress toward computer-assisted TKA. Orthopedics 22(7):698–702PubMedGoogle Scholar
  19. 19.
    Lotke PA, Ecker ML (1977) Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 59(1):77–79PubMedGoogle Scholar
  20. 20.
    Luo JW, Yu CT, Qin J, Xu DC (2006) Rotational malalignment causing patellofemoral complications after total knee replacement. Nan Fang Yi Ke Da Xue Xue Bao 26(2):217–219PubMedGoogle Scholar
  21. 21.
    Lüring C, Bathis H, Tingart M et al (2006) Computer assistance in total knee replacement - a critical assessment of current health care technology. Comput Aided Surg 11(2):77–80CrossRefPubMedGoogle Scholar
  22. 22.
    Lützner J, Krummenauer F, Wolf C et al (2008) Computer-assisted and conventional total knee replacement: A comparative, prospective, randomised study with radiological and ct evaluation. J Bone Joint Surg Br 90(8):1039–1044CrossRefPubMedGoogle Scholar
  23. 23.
    Macule-Beneyto F, Hernandez-Vaquero D, Segur-Vilalta JM et al (2006) Navigation in total knee arthroplasty. A multicenter study. Int Orthop 30(6):536–540CrossRefPubMedGoogle Scholar
  24. 24.
    Martin A, Wohlgenannt O, Prenn M et al (2007) Imageless navigation for TKA increases implantation accuracy. Clin Orthop Relat Res 460:178–184PubMedGoogle Scholar
  25. 25.
    Mason JB, Fehring TK, Estok R et al (2007) Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty 22(8):1097–1106CrossRefPubMedGoogle Scholar
  26. 26.
    Matziolis G, Krocker D, Weiss U et al (2007) A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am 89(2):236–243CrossRefPubMedGoogle Scholar
  27. 27.
    Molfetta L, Caldo D (2008) Computer navigation versus conventional implantation for varus knee total arthroplasty: a case-control study at 5 years follow-up. Knee 15(2):75–79CrossRefPubMedGoogle Scholar
  28. 28.
    Novak EJ, Silverstein MD, Bozic KJ (2007) The cost-effectiveness of computer-assisted navigation in total knee arthroplasty. J Bone Joint Surg Am 89(11):2389–2397CrossRefPubMedGoogle Scholar
  29. 29.
    Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res (299):153–156Google Scholar
  30. 30.
    Romero J, Stahelin T, Binkert C et al (2007) The clinical consequences of flexion gap asymmetry in total knee arthroplasty. J Arthroplasty 22(2):235–240CrossRefPubMedGoogle Scholar
  31. 31.
    Saragaglia D, Picard F, Chaussard C et al (2001) Computer-assisted knee arthroplasty: comparison with a conventional procedure. Results of 50 cases in a prospective randomized study. Rev Chir Orthop Reparat Apparat Mot 87(1):18–28Google Scholar
  32. 32.
    Slover JD, Tosteson AN, Bozic KJ et al (2008) Impact of hospital volume on the economic value of computer navigation for total knee replacement. J Bone Joint Surg Am 90(7):1492–1500CrossRefPubMedGoogle Scholar
  33. 33.
    Sparmann M, Wolke B (2003) Value of navigation and robot-guided surgery in total knee arthroplasty. Orthopade 32(6):498–505PubMedGoogle Scholar
  34. 34.
    Spencer JM. Chauhan SK, Sloan K et al (2007) Computer navigation versus conventional total knee replacement: no difference in functional results at two years. J Bone Joint Surg Br 89(4):477–480CrossRefPubMedGoogle Scholar
  35. 35.
    Stulberg SD, Yaffe MA, Koo SS (2006) Computer-assisted surgery versus manual total knee arthroplasty: a case-controlled study. J Bone Joint Surg Am 88(Suppl 4):47–54CrossRefPubMedGoogle Scholar
  36. 36.
    Weinrauch P, Myers N, Wilkinson M et al (2006) Comparison of early postoperative rehabilitation outcome following total knee arthroplasty using different surgical approaches and instrumentation. J Orthop Surg (Hong Kong) 14(1):47–52Google Scholar
  37. 37.
    Werner FW, Ayers DC, Maletsky LP, Rullkoetter PJ (2005) The effect of valgus/varus malalignment on load distribution in total knee replacements. J Biomech 38(2):349–355CrossRefPubMedGoogle Scholar
  38. 38.
    Windhagen H, Thorey F, Ostermeier S et al (2005) Navigator concept. Optimizing the procedure for navigated total knee arthroplasty. Orthopade 34(11):1125–1130CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  • O. Cerha
    • 1
    Email author
  • S. Kirschner
    • 1
  • K.-P. Günther
    • 1
  • J. Lützner
    • 1
  1. 1.Klinik und Poliklinik für Orthopädie Universitätsklinikum Carl Gustav Carus, Technische UniversitätDresdenDeutschland

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