title: [Computer-assisted joint replacement surgery. Financial and clinical impact for a specialised orthopaedic hospital].
abstract: OBJECTIVE
  Incorrect alignment is a known risk factor for early loosening of implants. Computer-assisted joint replacement surgery (CAS) improves the positioning of the used implants. So far there is no study comparing the improvement of radiological implant position and the extra costs for the CAS.
  
  
  METHODS
  We therefore analysed 200 (100 navigated procedures versus 100 conventional operations) total knee replacements and 60 (30 navigated procedures versus 30 conventional operations) hip resurfacing procedures. Evaluation criteria were radiological alignment and costs produced by using computer-assisted navigation tools.
  
  
  RESULTS
  In our series of total knee and hip resurfacing arthroplasties the number of outliers could be significantly reduced by using CAS. Patients receiving a navigated total knee replacement had a significantly lower blood loss and need for blood transfusion. The financial calculation for CAS for our specialised orthopaedic hospital showed that every CAS operation produced 442 euro extra costs per operation. So far these extra costs are not reimbursed.
  
  
  CONCLUSIONS
  By using CAS the implant positioning is significantly improved. Total knee replacements have a lower blood loss. Due to the prolonged operation time, the leasing costs and the single use navigation tools of every navigated operation produced costs for our hospital of 442 euro. As there is so far no reimbursement of these costs, long-term survival studies are needed to reveal the superiority of the navigation method and to show an impact on the medical budget.
authors.affiliation: LVR Klinik für Orthopädie, Viersen.
authors.forename: D P
authors.initials: DP
authors.lastname: König
authors.forename: J W-P
authors.initials: JW
authors.lastname: Michael
authors.forename: P
authors.initials: P
authors.lastname: Eysel
authors.forename: U
authors.initials: U
authors.lastname: Münnich
authors.forename: T
authors.initials: T
authors.lastname: Lichtenstein
authors.forename: C
authors.initials: C
authors.lastname: Schnurr
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000191:economics; D002017:Budgets; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D007860:Leasing, Property / Q000191:economics; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D015207:Osteoarthritis, Hip / Q000191:economics* / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000191:economics* / Q000601:surgery; D016311:Outliers, DRG / Q000191:economics; D012051:Reimbursement Mechanisms / Q000191:economics; D025321:Surgery, Computer-Assisted / Q000191:economics*