Ceramic Femoral Heads for All Patients? An Argument for Cost Containment in Hip Surgery
- Cody C. Wyles, Benjamin A. McArthur, Eric R. Wagner, Matthew T. Houdek, Jose H. Jimenez-Almonte, Robert T. Trousdale
- Am J Orthopaedics 2016 September; 45(6):E362-E366
- Level of Evidence:
- None given.
Trunnionosis from modular connections of total hip arthroplasties (THA) is also an issue with metalon-polyethylene (MoP) bearings, and can lead to increased complications such as painful THA or revisions (see also Monthly CeraNews December 2016). The diagnosis and management of adverse local tissue reactions (ALTRs) is complex and cost-intensive. As ceramic femoral heads can mitigate this issue, a cost effectiveness model was developed by the authors.
The cost estimation for an ALTR work-up was calculated following a published guideline (Kwon et al JBJS 2014). Aspects of this were imaging (MRI, ultrasonography, radiography), serum and aspiration tests, and clinical appointments and procedures including revision. The costs for the tests were taken from in-house data. The authors created two models:
1) additional cost for a ceramic femoral head and
2) cut-off value for cost effectiveness of a ceramic femoral head. Ceramic head prices were determined from 3 different practice sources for 2 different suppliers. The simulations were based on a previous finding that 7% of THA patients with MoP bearings present groin pain and that 12.5, 25 or 50% of these receive an ALTR work-up or are revised.
The cost for a single ALTR work-up was $5,085 with MRI and $2,402. Revision with 3-day stay costs $53,320 without perioperative medications and devices. Ceramic head extra cost was between $500 and $1,500.
The authors concluded that their model suggests that ceramic femoral heads could be more costeffective than cobalt-chrome alloy femoral heads. In regards to ALTRs, ceramic femoral ball heads show a superior safety profile and wholesale use in THA may in fact provide the most economical option on a societal scale.
- Use of 7% as the incidence of painful conventional THA (self-reported)
- Based on only one clinical complication – trunnionosis
- Cost from one finance department at one institution
- Cost estimation only valid for the USA
- Trunnionosis is a serious complication, also with MoP implants.
- Additional cost for a ceramic femoral head in the US was $500 – $1,500.
- Ceramic femoral heads could be more cost-effective than CoCr femoral heads based on avoidance of the consequences of metal release.