title: Computer-Navigated Total Knee Arthroplasty Utilization.
abstract: Computer-navigated total knee arthroplasty (CN-TKA) has been used to improve component alignment, though the evidence is currently mixed on whether there are clinically significant differences in long-term outcomes. Given the established increased costs and operative time, we hypothesized that the utilization rate of CN-TKA would be decreasing relative to standard TKA in the Medicare population given the current health care economic environment. We queried 1,914,514 primary TKAs performed in the entire Medicare database from 2005 to 2012. Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to identify and separate CN-TKAs. Utilization of TKA was compared by year, gender, and region. Average change in cases per year and compound annual growth rate (CAGR) were used to evaluate trends in utilization of the procedure. We identified 30,773 CN-TKAs performed over this time period. There was an increase in utilization of CN-TKA per year from 984 to 5,352 (average = 572/year, R (2) = 0.85, CAGR = 23.58%) from 2005 to 2012. In contrast, there was a slight decrease in overall TKA utilization from 264,345 to 230,654 (average = 4297/year, R (2) = 0.74, CAGR = - 1.69%). When comparing proportion of CN-TKA to all TKAs, there was an increase from 0.37 to 2.32% (average 0.26%/year, R (2) = 0.88, CAGR = 25.70%). CN-TKA growth in males and females was comparable at 24.42 and 23.11%, respectively. The South region had the highest growth rate at 28.76%, whereas the Midwest had the lowest growth rate at 15.51%. The Midwest was the only region that peaked (2008) with a slow decline in utilization until 2012. Despite increased costs with unclear clinical benefit, CN-TKA is increasing in utilization among Medicare patients. Reasons could include patient preference, advertising, proper of coding the procedure, and increased publicly available information about arthroplasty options.
authors.affiliation: School of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Abiram
authors.initials: A
authors.lastname: Bala
authors.affiliation: School of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Colin Thomas
authors.initials: CT
authors.lastname: Penrose
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Thorsten Markus
authors.initials: TM
authors.lastname: Seyler
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Richard Chad
authors.initials: RC
authors.lastname: Mather
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Samuel Secord
authors.initials: SS
authors.lastname: Wellman
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Michael Paul
authors.initials: MP
authors.lastname: Bolognesi
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data*; D014481:United States