Does Implant Design Affect Hospital Metrics and Patient Outcomes? TKA Utilizing a “Fast-Track” Protocol

• Main Authors: Richard Buch, Lennart Schroeder, Rylie Buch, Robert Eberle
• Format: Article
• Language: English
• Published: Joint Implant Surgery & Research Foundation 2019-04-01
• Series: Reconstructive Review
• Subjects: Fast Track, customized, Total Knee Arthroplasty
• Online Access: https://reconstructivereview.org/ojs/index.php/rr/article/view/203

Introduction “Fast-Track” protocols have been introduced in TKA with the intention to increase health care savings while maintaining or improving patient outcomes. The influence of the implant design in a “Fast-Track” setting has not been described yet. The primary goal of this study was to compare a customized implant with standard off-the-shelf (OTS) devices when utilizing a “Fast-Track” protocol Methods Sixty-two (62) patients were prospectively enrolled at a single center and implanted with either a customized or a standard off-the-shelf implant resulting in thirty (30) patients being treated with an OTS design and thirty-two (32) with the customized design. The same institutional fast-track protocol was utilized on all patients and included pre-, intra-, and postoperative medical treatment. We assessed total length of stay (LOS), discharge destination and range of motion at 6-8 weeks post-op and at an average of 16 months post-op follow-up to compare the OTS implant with the customized device. Implant survivorship was assessed at a minimum of 25 months post-op. Results Using the fast track protocol we were able to decrease overall LOS to 2.1 days versus 3.6 days prior to introduction of the protocol. The use of the customized implant further reduced LOS significantly to 1.6 days. Significantly higher number of patients who got implanted with the customized device (66%) were discharged within 24 hours than in the OTS group (30%). Patients treated with the customized implant were found to be discharged home more often than patients treated with the OTS implants (97% vs. 80%) and achieved higher range of motion both at 6-8 weeks (114° vs. 101°) and at an average of 16 months (122° vs. 114°) than patients who got treated with the OTS device. At an average follow-up of 28 months, there was 1 implant revision in the customized group (due to tibial fracture resulting from patient fall). For the OTS group there was 1 implant revision (late infection) and 1 poly swap (due to instability). Discussion Based on our analysis we observed a positive influence of the customized device on patient outcomes and hospital metrics and we therefore conclude that the implant choice is an important factor for TKA in a “fast-track” setting.