A Thès1, V Molina2, T Lambert3. 1. Service de chirurgie orthopédique, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France. Electronic address: andre.thes@gmail.com. 2. Service de chirurgie orthopédique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France. 3. Centre de référence pour le traitement de l'hémophilie, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
Abstract
INTRODUCTION: Simultaneous bilateral total knee arthroplasty (TKA) is proposed in the general population as an alternative to staged bilateral TKA and has the advantage of reducing costs with equivalent complication rates. The aim of this study was to evaluate the cost-effectiveness of this alternative in a population of patients with severe hemophilia. HYPOTHESIS: Simultaneous bilateral TKA is less expensive than staged bilateral TKA. MATERIALS AND METHODS: We performed a retrospective case control study in patients with severe hemophilia A to compare the direct costs of coagulation factors, the length of hospital stay and sick leave as well as the clinical outcome (KKS) of simultaneous bilateral TKA (group 1; G1: 5 patients) and staged bilateral TKA (group 2; G2: 12 patients). RESULTS: The mean cost of coagulation factors was 65,880 € in G1 and 139,000 € in G2 (P<0.001). The length of the hospital stay (24 days vs 44 cumulative days, respectively) and sick leave (105 days vs 183 cumulative days, respectively) was significantly reduced in G1. There was no significant difference in clinical outcome at the final follow-up. One patient in G2 had a late knee infection. DISCUSSION: Simultaneous bilateral TKA in severe hemophilia is associated with lower costs than staged bilateral TKA with equivalent clinical results. LEVEL OF EVIDENCE: Level 3, case control study.
INTRODUCTION: Simultaneous bilateral total knee arthroplasty (TKA) is proposed in the general population as an alternative to staged bilateral TKA and has the advantage of reducing costs with equivalent complication rates. The aim of this study was to evaluate the cost-effectiveness of this alternative in a population of patients with severe hemophilia. HYPOTHESIS: Simultaneous bilateral TKA is less expensive than staged bilateral TKA. MATERIALS AND METHODS: We performed a retrospective case control study in patients with severe hemophilia A to compare the direct costs of coagulation factors, the length of hospital stay and sick leave as well as the clinical outcome (KKS) of simultaneous bilateral TKA (group 1; G1: 5 patients) and staged bilateral TKA (group 2; G2: 12 patients). RESULTS: The mean cost of coagulation factors was 65,880 € in G1 and 139,000 € in G2 (P<0.001). The length of the hospital stay (24 days vs 44 cumulative days, respectively) and sick leave (105 days vs 183 cumulative days, respectively) was significantly reduced in G1. There was no significant difference in clinical outcome at the final follow-up. One patient in G2 had a late knee infection. DISCUSSION: Simultaneous bilateral TKA in severe hemophilia is associated with lower costs than staged bilateral TKA with equivalent clinical results. LEVEL OF EVIDENCE: Level 3, case control study.