Does Femoral Component Cementation Affect Costs or Clinical Outcomes After Hip Arthroplasty in Medicare Patients

Abstract Background Bundled payment initiatives were introduced to reduce costs and improve quality of care. Cemented versus cementless femoral fixation is a modifiable variable that may influence the cost and quality of care. New bundled payments data from the Centers for Medicare and Medicaid Services (CMS) allowed us to study the influence of femoral fixation strategy on 90-day costs and clinical outcomes. Questions/purposes How does the method of femoral fixation affect (1) 90-day costs; (2) readmission rates; (3) reoperation rates; (4) length of stay (LOS); and (5) discharge disposition for Medicare patients undergoing THA? Methods We retrospectively studied 1671 primary THA Medicare cases, comparing 359 patients who received cemented femoral fixation to 1312 who received cementless fixation. CMS cost data as well as clinical data were reviewed. Demographic differences were present between the two cohorts. Statistical analyses were performed, including multiple regression models to adjust for baseline differences. Results Controlling for cohort differences, cemented patients were significantly more likely to be discharged home compared to cementless patients. Cemented patients also demonstrated trends toward lower costs, lower readmission rates, and shorter LOS compared to cementless patients. All reoperations within the early postoperative period occurred in patients managed with cementless femoral fixation. Conclusion Among Medicare patients, cemented femoral fixation outperformed cementless fixation with respect to discharge disposition and also trended toward superiority with regards to LOS, readmission, cost of care, and reoperation. Cemented femoral fixation remains relevant and useful despite the rising popularity of cementless fixation.