title: What are estimated reimbursements for lower extremity prostheses capable of surgical and nonsurgical lengthening?
abstract: BACKGROUND
  Growing prostheses accommodate skeletally immature patients with bone tumors undergoing limb-preserving surgery. Early devices required surgical procedures for lengthening; recent devices lengthen without surgery. Expenses for newer expandable devices that lengthen without surgery are more than for their predecessors but overall reimbursement amounts are not known.
  
  
  OBJECTIVE
  We sought to determine reimbursement amounts associated with lengthening of growing prostheses requiring surgical and nonsurgical lengthening.
  
  
  METHODS
  We retrospectively reviewed 17 patients with growing prostheses requiring surgical expansion and eight patients with prostheses capable of nonsurgical expansion. Insurance documents were reviewed to determine the reimbursement for implantation, lengthening, and complications. Growth data were obtained from the literature.
  
  
  RESULTS
  Mean reimbursement amounts of surgical and nonsurgical lengthenings were $9950 and $272, respectively. Estimated reimbursements associated with implantation of a growing prosthesis varied depending on age, sex, and location. The largest difference was found for 4-year-old boys with distal femoral replacement where reimbursement for expansion to maturity for surgical and nonsurgical lengthening prostheses would be $379,000 and $208,000, respectively. For children requiring more than one surgical expansion, net reimbursements were lower when a noninvasive lengthening device was used. Annual per-prosthesis maintenance reimbursements to address complications for surgical and nonsurgical lengthening prostheses were $3386 and $1856, respectively.
  
  
  CONCLUSIONS
  This study showed that reimbursements for lengthening of growing endoprostheses capable of nonsurgical expansion may be less expensive in younger patients, particularly male patients undergoing distal femur replacement, than endoprostheses requiring surgical lengthening. Longer outcomes studies are required to see if reimbursements for complications differ between devices.
  
  
  METHODS
  Level III, economic and decision analysis. See the Guidelines for Authors for a complete description of levels of evidence.
authors: Department of Orthopaedics & Sports Medicine, University of South Florida, 13220 Laurel Drive, MDF 5th Floor, MDC 6, Tampa, FL 33612, USA. eric.r.henderson@gmail.com
authors: Eric R
authors: ER
authors: Henderson
authors: Andrew M
authors: AM
authors: Pepper
authors: G Douglas
authors: GD
authors: Letson
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D005266:Femoral Neoplasms / Q000191:economics* / Q000601:surgery; D005269:Femur / Q000601:surgery*; D017048:Health Care Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008297:Male; D012516:Osteosarcoma / Q000191:economics* / Q000601:surgery; D019736:Prostheses and Implants / Q000191:economics*; D012189:Retrospective Studies; D012737:Sex Factors