Is resurfacing the patella cheaper? An economic analysis of evidence based medicine on patellar resurfacing

• Medicare pays the same for CPT code 27447 (TKA) regardless of patellar resurfacing or not.
• Financial implications of resurfacing versus not resurfacing have not been demonstrated
• An expected-value decision tree using RCTs compares patellar resurfacing versus nonresurfacing
• Expected value of primary TKA WITH patellar resurfacing was $13,788.48
• Expected value a primary TKA WITHOUT patellar resurfacing was $14,016.41
• Resurfacing the patella during a primary TKA is the optimal financial strategy

BackgroundPrimary total knee arthroplasty is a high volume procedure which is expected to grow dramatically in the near future. The decision to resurface the patella has been discussed extensively in the literature yet the financial implications of resurfacing versus not resurfacing have not been demonstrated.MethodsWe identified all randomized controlled trials comparing patellar resurfacing to nonresurfacing in the past ten years and identified the total number of patellofemoral revision surgeries for both resurfaced and nonresurfaced patellas in each study. An expected-value decision tree analysis was created using only data from the randomized controlled trials. Actual costs collected from Medicare reimbursement rates were then applied to the model and a sensitivity analysis was performed.ResultsThe expected value of primary total knee arthroplasty with patellar resurfacing was $13,788.48 while a primary total knee arthroplasty without patellar resurfacing was $14,016.41 after five years. The difference represents an additional $227.92 of Medicare dollars for every primary total knee arthroplasty performed without patellar resurfacing at five years. The model remains valid as long as patellofemoral revision rates after patellar resurfacing remain below 3.54% and patellofemoral revision rates after nonresurfaced patellas remain above 0.77%.ConclusionsWhile initially counterintuitive, resurfacing the patella during a primary total knee arthroplasty is the optimal financial strategy from a Medicare perspective over a mid term period.