Trends in Practice Patterns of Conventional and Computer-Assisted Knee Arthroplasty

An Analysis of 570,671 Knee Arthroplasties Between 2010 and 2017

Abdalrahman G. Ahmed; Raymond Kang, MA; Mohamed Hasan, MD, MPH; Yao Tian, PhD, MS, MPH; Hassan M. Ghomrawi, PhD, MPH

Disclosures

J Am Acad Orthop Surg. 2021;29(22):e1117-e1125. 

In This Article

Results

Over the study period, 261,957 KAs were performed in New York state of which 19,706 (7.52%) were CAKA, and 308,714 KAs performed in Florida of which 16,634 (5.39%) were CAKA (Table 2). In both New York and Florida, most CAKAs were coded using the general CA code for computer-assisted surgery, which did not specify modality. The ICD-9 code for other computer-assisted surgery, 00.39, represented 74.0% of the CAKAs. The general ICD-10-CM code for computer-assisted procedure of lower extremity, 8E0YXBZ, represented 96.8% of all CAKAs.

In New York, the proportion of CAKAs increased in rate from 4.89% in 2010Q1 to 9.45% in 2017Q3, with a peak of 10.1% in 2015Q3. A 93.3% growth in the utilization of computer-assisted navigation technology was seen in New York during the study period (Figure 1). In Florida, the proportion of CAKAs increased from 4.03% in 2010Q1 to 5.73% in 2017Q3 with a peak of 7.25% in 2014Q3. A 42.2% growth in the utilization of computer-assisted technology was seen in Florida during the study period (Figure 2).

Figure 1.

Graphs showing the rates of computer-assisted knee arthroplasty by race (A) and insurance type (B) in New York.

Figure 2.

Graphs showing the rates of computer-assisted knee arthroplasty by race (A) and insurance type (B) in Florida.

Bivariate analysis showed that the conventional KA and CAKA cohorts were quite similar on most demographic variables; the significant P values were driven by large sample size. For example, in the largest age group (65 to 74), the percent of NY CAKA patients aged 65 to 74 years was 34% (FL 37%) compared with 32% (FL 38%) in the conventional group. However, there were larger differences by race and insurance type. A higher proportion of CAKA patients were non-Hispanic-White (NHW) (NY 84%, FL 85%) compared with conventional patients (NY 74%, FL 80%), respectively (Table 2).

Differences by race and insurance type were also observed over time. In New York, the NHW patients had higher rates of CAKAs than Black patients at 5.55% versus 2.7% (P < 0.001) in 2010Q1 and 11.24% versus 8.50% (P = 0.019) in 2017Q3. The CAKA rates by insurance type were higher for the Medicare and Commercial beneficiaries compared with the Medicaid beneficiaries at 5.26% (P = 0.004) and 4.64% (0.008) versus 0.05% in 2010Q1 and 9.49% (P < 0.001) and 10.56% (P < 0.001) versus 3.64% in 2017Q3 (Figure 1). In Florida, the CAKAs rates for NHW patients were higher than those of Black and Hispanic patients at 4.25% versus 2.05% (P = 0.007) and 2.63% (P = 0.045) in 2010Q1 and 6.11% versus 5.04% (P = 0.180) and 3.63% (P < 0.001) in 2017Q3. The CAKA rates by insurance type in Florida were higher for Medicare and Commercial beneficiaries compared with Medicaid beneficiaries at 4.02% (P = 0.075) and 4.55% (P = 0.047) versus 1.25% in 2010Q1 and 5.68% (P = 0.925) and 5.69% (P = 0.963) versus 5.77% in 2017Q3 (Figure 2).

In multivariate analysis, Black and Hispanic patients were less likely to receive CAKAs than NHW patients in both New York (odds ratio [OR]: 0.63, 95% confidence interval [CI], 0.60 to 0.67) (OR: 0.45, CI, 0.41 to 0.50) and Florida (Black OR: 0.75, CI, 0.70 to 0.81, Hispanic OR: 0.65, Cl: 0.61 to 0.71). Patients with Medicaid insurance were also less likely to receive CAKAs in New York (OR: 0.46, CI, 0.40 to 0.53), but not Florida (OR: 1.11, CI, 0.95 to 1.30) (Table 3). Results were similar when we ran the models separately for ICD-9 and ICD-10 eras (see Supplemental Digital Content, Table A.2 and Table A.3, http://links.lww.com/JAAOS/A591).

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