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Olawale A Sogbein,1,2 Jacquelyn D Marsh,1 Lyndsay E Somerville,1 James L Howard,1 Brent A Lanting1 1Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre – University Hospital, London, Ontario, Canada; 2Schulich School of Medicine & Dentistry, Western University, London, Ontario, CanadaCorrespondence: Olawale A Sogbein, Tel +1 519-476-1151, Email olsogbein@nosm.caBackground: We recently performed a clinical trial comparing motor sparing blocks (MSB) to periarticular infiltration (PAI) following total knee arthroplasty (TKA). We found that MSBs provided longer analgesia (8.8 hours) than PAI with retention of quadriceps strength, and with similar function, satisfaction, and length hospital stay. However, its potential increased cost could serve as a barrier to its adoption. Therefore, our aim was to compare the costs of MSBs to PAI following TKA.Methods: We conducted a retrospective review of data from our previous RCT. There were 82 patients included in the RCT (n = 41 MSB group, n = 41 PAI group). We compared the mean total costs associated with each group until hospital discharge including intervention costs, health-care professional service fees, intraoperative medications, length of stay, and postoperative opioid use.Results: Seventy patients were included (n = 35 MSB group, n = 35 PAI group). The mean total costs for the MSB group were significantly higher ($1959.46 ± 755.4) compared to the PAI group ($1616.25 ± 488.33), with a mean difference of $343.21 (95% CI = $73.28 to $664.11, p = 0.03). The total perioperative intervention costs for performing the MSB was also significantly higher; however, postoperative inpatient costs including length of stay and total opioid use did not differ significantly.Conclusion: Motor sparing blocks had significantly higher mean total and perioperative costs compared to PAI with no significant difference in postoperative inpatient costs. However, its quadricep sparing nature and previously

Olawale A Sogbein,1,2 Bryn O Zomar,1,3 Dianne M Bryant,3 James L Howard,1 Jacquelyn D Marsh,1 Brent A Lanting1 1London Health Sciences Centre – University Hospital, Division of Orthopaedic Surgery, Department of Surgery, London, Ontario, Canada; 2Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; 3Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, CanadaCorrespondence: Olawale A Sogbein, Tel +1 519-476-1151, Email olsogbein@nosm.caIntroduction: Total knee arthroplasty (TKA) is one of the most successful procedures for the treatment of severe knee osteoarthritis. Various surgical approaches have been investigated in the hopes of improving postoperative outcomes. Two include the medial parapatellar (standard) and midvastus. As the midvastus approach does not disrupt the extensor mechanism, it may be advantageous for functional recovery, however length of stay and long-term function are similar between approaches. Tourniquet use during TKA has conflicting results in the literature. We hypothesized that a future trial comparing outpatient versus standard TKA could appropriately use either surgical approach with or without a tourniquet. Therefore, the objective of this pilot randomized trial was to compare postoperative pain, function, quality of life, and satisfaction between patients who underwent a medial parapatellar or midvastus approach for TKA ± tourniquet use.Methods: We conducted a randomized trial with a two-by-two factorial design to compare the medial parapatellar to the midvastus surgical approach for TKA ± tourniquet use. The Short Form-12 (SF-12), Western Ontario McMaster Osteoarthritis Index (WOMAC), and Knee Society Score (KSS) were collected at baseline, postoperatively at two, six, 12 weeks, and one year.Results: Eighty-three patients were included. Postoperative WOMAC scores were statistically but not clinically higher at six weeks and three months in favour of no tourniquet u

Bryn O Zomar, 1–3 Shannon L Sibbald, 1 Doug Bickford, 4 James L Howard, 2, 5 Dianne M Bryant, 1, 3 Jacquelyn D Marsh, 1, 3 Brent A Lanting 2, 3, 5  1Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; 2London Health Sciences Centre, London, ON, Canada; 3Bone and Joint Institute, University of Western Ontario, London, ON, Canada; 4Southwestern Ontario Stroke Network, London, ON, Canada; 5Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, CanadaCorrespondence: Brent A Lanting 339 Windermere Road, Rm B9-003, London, ON N6A 5A5, CanadaTel +1 519-663-3335Email brent.lanting@lhsc.on.caAbstract: Total joint arthroplasties (TJA) are successful procedures for the treatment of end-stage hip and knee arthritis. Length of stay in hospitals after these procedures has been steadily decreasing over time, with outpatient procedures (discharge on the same day as surgery) introduced in the US within the last 20 years. Reducing length of stay after TJA can provide cost savings. Centres in Canada have started to utilize outpatient TJA procedures, but we have identified some barriers that may have limited their implementation. We have summarized the current literature for outpatient TJA and discussed potential solutions for the current barriers.Keywords: total knee arthroplasty, total hip arthroplasty, outpatient, implementation, barriers

ObjectiveTo determine the cost-effectiveness of arthroscopic surgery in addition to non-operative treatments compared with non-operative treatments alone in patients with knee osteoarthritis (OA).Design, setting and participantsWe conducted an economic evaluation alongside a single-centre, randomised trial among patients with symptomatic, radiographic knee OA (KL grade ≥ 2).InterventionsPatients received arthroscopic debridement and partial resection of degenerative knee tissues in addition to optimised non-operative therapy, or optimised non-operative therapy only.Main outcome measuresDirect and indirect costs were collected prospectively over the 2-year study period. The effectiveness outcomes were the Western Ontario McMaster Osteoarthritis Index (WOMAC) and quality-adjusted life years (QALYs). Cost-effectiveness was estimated using the net benefit regression framework considering a range of willingness-to-pay values from the Canadian public payer and societal perspectives. We calculated incremental cost-effectiveness ratios and conducted sensitivity analyses using the extremes of the 95% CIs surrounding mean differences in effect between groups.Results168 patients were included. Patients allocated to arthroscopy received partial resection and debridement of degenerative meniscal tears (81%) and/or articular cartilage (97%). There were no significant differences between groups in use of non-operative treatments. The incremental net benefit was negative for all willingness-to-pay values. Uncertainty estimates suggest that even if willing to pay $400,000 to achieve a clinically important improvement in WOMAC score, or ≥$50,000 for an additional QALY, there is <20% probability that the addition of arthroscopy is cost-effective compared with non-operative therapies only. Our sensitivity analysis suggests that even when assuming the largest treatment effect, the addition of arthroscopic surgery is not economically attractive compared with non-operative treatments o

ObjectiveTo determine the cost-effectiveness of arthroscopic surgery in addition to non-operative treatments compared with non-operative treatments alone in patients with knee osteoarthritis (OA).Design, setting and participantsWe conducted an economic evaluation alongside a single-centre, randomised trial among patients with symptomatic, radiographic knee OA (KL grade ≥ 2).InterventionsPatients received arthroscopic debridement and partial resection of degenerative knee tissues in addition to optimised non-operative therapy, or optimised non-operative therapy only.Main outcome measuresDirect and indirect costs were collected prospectively over the 2-year study period. The effectiveness outcomes were the Western Ontario McMaster Osteoarthritis Index (WOMAC) and quality-adjusted life years (QALYs). Cost-effectiveness was estimated using the net benefit regression framework considering a range of willingness-to-pay values from the Canadian public payer and societal perspectives. We calculated incremental cost-effectiveness ratios and conducted sensitivity analyses using the extremes of the 95% CIs surrounding mean differences in effect between groups.Results168 patients were included. Patients allocated to arthroscopy received partial resection and debridement of degenerative meniscal tears (81%) and/or articular cartilage (97%). There were no significant differences between groups in use of non-operative treatments. The incremental net benefit was negative for all willingness-to-pay values. Uncertainty estimates suggest that even if willing to pay $400,000 to achieve a clinically important improvement in WOMAC score, or ≥$50,000 for an additional QALY, there is <20% probability that the addition of arthroscopy is cost-effective compared with non-operative therapies only. Our sensitivity analysis suggests that even when assuming the largest treatment effect, the addition of arthroscopic surgery is not economically attractive compared with non-operative treatments o