This is a timely retrospective study comparing 92 all-polyethylene tibias to 96 metal-backed total knee replacements in 188 patients and their 90-day reported quality metrics, along with differences in hospital and total costs. While the authors point to previous literature reporting that the mid- and long-term outcomes in older patients are equivalent, their study emphasizes the 6.2% decrease in hospital-based costs with all-polyethylene tibias. With increasing numbers of total knees being performed and an exponential rise in numbers expected over the next 10 years, it is important for arthroplasty surgeons to consider the cost basis of their treatment, including implant costs. The authors also found a significant decrease in operative time for the all-polyethylene tibia group (which can further decrease operating room costs), which they noted was unexpected, but attributed this to less time trialing and shorter time to closure once the all-polyethylene tibia was implanted. I appreciate the authors’ efforts in this time of the Comprehensive Care for Joint Replacement and bundled payments to highlight the possible cost savings with all-polyethylene tibia in older patients with a lower BMI and the possible realization of hospital cost savings, which may be considerable.
William M. Mihalko, MD, PhD
Professor and JR Hyde Chair in Rehabilitative Engineering
Joint Graduate Program Chair in Biomedical Engineering
Campbell Clinic department of orthopedic surgery and biomedical engineering
University of Tennessee Health Science Center
Memphis, Tennessee
Disclosures: Mihalko reports he is a board or committee member for the American Academy of Orthopaedic Surgeons, the American Society for Testing Materials International, the Campbell Foundation, the Knee Society and Orthopaedic Research Society; receives IP royalties from Aesculap/B.Braun; is a paid consultant for Aesculap/B.Braun, Pacira Inc. and Zimmer; is a paid presenter or speaker for Aesculap/B.Braun and Pacira Biosciences Inc.; receives research support from Aesculap/B.Braun, the Department of Defense, Myoscience Inc., the National Institutes of Health (NIAMS & NICHD) and Stryker; is on the editorial or governing board for the Journal of Arthroplasty, Journal of Orthopaedic Research, Orthopedic Clinics of North America and the Journal of Long Term Effects of Medical Implants; and receives publishing royalties, financial or material support from Saunders/Mosby-Elsevier.
