COST EFFECTIVENESS OF COMPUTER NAVIGATION FOR TOTAL JOINT ARTHROPLASTY IN A COMMUNITY HOSPITAL

Abstract

Introduction: While computer navigation has been shown to improve radiographic alignment and eliminate outliers in limb and component position in total joint arthoplasty, adoption has been relatively slow. One argument against the use of navigation has been the concern about the cost of the capital equipment and surgical disposables. The purpose of this paper was to evaluate whether the direct cost of patient care was greater for the senior author, who navigates all joint replacements, than other surgeons, who perform total joint arthroplasty without navigation.

Methods: The author’s institution is a 200 bed community hospital that performs over 1000 joint replacements per year. This study consisted of reviewing the fiscal year 2007 data at the author’s institution and comparing the direct costs of medical care, length of stay and discharge disposition for the senior author to his peers at his institution.

Results: In fiscal year 2007, the hospital performed 624 primary total knee and 213 primary total hip replacements of which the senior author performed 284(45%) knees and 156(73%) hips respectively. The average charge for the entire hospital was $38, 877 and LOS was 2.7 days for knees, and charges of $40, 076 and LOS was 2.7 days for hips. The senior authors charges were $33, 801 and LOS was 2.4 days for knees and $36, 403 and LOS 2.4 for hips. 78% of the knees and 81 % of the hips were discharged to home overall for the institution and 86% of both knees and hips by the senior author. The capital equipment purchase for navigation was $204,000 or $463 per primary arthroplasty(senior author).

Conclusions: Computer navigation did not increase the direct cost of primary total joint replacement for the senior author relative to his peers even if the entire capital equipment purchase was added to the case cost.