Do "premium" joint implants add value?: analysis of high cost joint implants in a community registry

Abstract

Background: Numerous joint implant options of varying cost are available to the surgeon, but it is unclear whether more costly implants add value in terms of function or longevity.

Questions/purposes: We evaluated registry survival of higher-cost "premium" knee and hip components compared to lower-priced standard components.

Methods: Premium TKA components were defined as mobile-bearing designs, high-flexion designs, oxidized-zirconium designs, those including moderately crosslinked polyethylene inserts, or some combination. Premium THAs included ceramic-on-ceramic, metal-on-metal, and ceramic-on-highly crosslinked polyethylene designs. We compared 3462 standard TKAs to 2806 premium TKAs and 868 standard THAs to 1311 premium THAs using standard statistical methods.

Results: The cost of the premium implants was on average approximately $1000 higher than the standard implants. There was no difference in the cumulative revision rate at 7-8 years between premium and standard TKAs or THAs.

Conclusions: In this time frame, premium implants did not demonstrate better survival than standard implants. Revision indications for TKA did not differ, and infection and instability remained contributors. Longer followup is necessary to demonstrate whether premium implants add value in younger patient groups.

Level of evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Fig. 1

A graph shows the CRR by type of implant for TKA. There was no difference (p = 0.94) in the CRR between premium and standard TKAs at 7 years (2.2% versus 3.0%). CI = confidence interval.

Fig. 2

A graph shows the CRR by type of implant for THA. There was no difference (p = 0.24) in the CRR between premium and standard THAs at 7 years (4.6% versus 3.2%). CI = confidence interval.