title: Preoperative Interventions and Charges Before Total Knee Arthroplasty.
abstract: The cost effectiveness of total knee arthroplasty (TKA) has been well established, but little data exist regarding preoperative interventions and their costs. The purpose of this study was to examine preoperative interventions and their associated charges within the 2-year period before TKA.
  
  
  
  A retrospective cohort analysis of patients undergoing TKA between 2007 and 2011 was conducted using the PearlDiver Patient Record Database. Patients' inpatient and outpatient billing records were tracked over the 2-year period before receiving a TKA.
  
  
  
  A total of 35,596 patients from Medicare and 47,064 from United Healthcare underwent TKA from 2009 to 2011. In the 2-year period before TKA, the per patient average charge was $3545.82 for Medicare and $3281.57 for United Healthcare. In the 2-year period before TKA, 21.4% (Medicare) and 23.3% (United Healthcare) of all patients received a magnetic resonance imaging, with between 31.9% (Medicare) and 45.6% (United Healthcare) of these occurring within 3 months of surgery (P < .05). During this same period, 49.4% (Medicare) and 63.2% (United Healthcare) of all patients received an intra-articular injection, with between 29.4% (Medicare) and 44.8% (United Healthcare) of these occurring within 3 months of surgery (P < .05).
  
  
  
  Interventions and costs before TKA occur largely within 6 months preoperatively, with a substantial portion occurring within 3 months. These interventions may not be clinically or cost effective for certain patients, such as those with moderate-to-severe osteoarthritis. Foregoing these interventions and opting to perform TKA earlier may reduce costs and prevent unnecessary tests and procedures.
authors.affiliation: David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Orthopaedic Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California.
authors.forename: Jeremiah R
authors.initials: JR
authors.lastname: Cohen
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Bradley
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California.
authors.forename: Jay R
authors.initials: JR
authors.lastname: Lieberman
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000191:economics; D019645:Arthroplasty, Replacement, Knee; D003362:Cost-Benefit Analysis; D005249:Fees and Charges; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D009819:Office Visits / Q000191:economics; D010003:Osteoarthritis; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000191:economics* / Q000628:therapy*; D026741:Physical Therapy Modalities / Q000191:economics; D011300:Preoperative Care; D012189:Retrospective Studies; D014481:United States
keywords: Medicare; PearlDiver; United Healthcare; preoperative interventions; total knee arthroplasty