Pelvic discontinuity treated with custom triflange component: a reliable option.

BACKGROUND: Pelvic discontinuity is an increasingly common complication of THA. Treatments of this complex situation are varied, including cup-cage constructs, acetabular allografts with plating, pelvic distraction technique, and custom triflange acetabular components. It is unclear whether any of these offer substantial advantages. QUESTIONS/PURPOSES: We therefore determined (1) revision and overall survival rates, (2) discontinuity healing rate, and (3) Harris hip score (HHS) after treatment of pelvic discontinuity with a custom triflange acetabular component and (4) the cost of this reconstructive operation compared to other constructs. METHODS: We retrospectively reviewed 57 patients with pelvic discontinuity treated with revision THA using a custom triflange acetabular component. We reviewed operative reports, radiographs, and clinical data for clinical and radiographic results. We also performed a cost comparison with utilization of other techniques. Minimum followup was 24 months (average, 65 months; range, 24-215 months). RESULTS: Fifty-six of 57 (98%) were free of revision for aseptic loosening at latest followup. Fifty-four (95%) were free of revision of the triflange component for any reason. Thirty-seven (65%) were free of revision for any reason. Twenty-eight (49%) were free of revision for any reason and free of any component migration and had a healed discontinuity. Forty-six (81%) had a stable triflange component with a healed pelvic discontinuity. Average HHS was 74.8. The costs of the custom triflange implants and a Trabecular Metal cup-cage construct were equivalent: $12,500 and $11,250, respectively. CONCLUSIONS: In this group of patients with osteolytic pelvic discontinuity, triflange implants provided predictable mid-term fixation at a cost equivalent to other treatment methods. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

[Cost analysis of tumor-induced osteolysis treated with intravenous zoledronic acid and pamidronate: a time-motion study]. / Analisi dei costi di trattamento dell'osteolisi tumorale con acido zoledronico e pamidronato per via endovenosa: uno studio tempi & metodi.

A time-motion study was performed by evaluating time and use of medical supply resources in the administration of zoledronic acid and pamidronate as palliative care of tumor-induced osteolysis within the clinical setting of three Italian oncology day-hospital sites. The direct medical costs were similar for both treatments (Euro 226 for zoledronic acid versus Euro 231 for pamidronate). With the exclusion of the pharmacological therapy, most of the difference in costs derives from nurses' labor costs, which is related to the longer infusion time for pamidronate (1 h, 47 min versus 28 min for zoledronic acid).

Cost-effectiveness of early surgical intervention in silent osteolysis.

Access to subspecialty care is the subject of significant controversy. Most managed-care systems closely monitor the number of specialist referrals as well as x-rays ordered for patients with no symptoms, but large lytic lesions can exist around implants without any pain. Intervention costs were calculated for 2 groups of patients: 1 group with silent lysis with no symptoms and another group with periprosthetic fractures around lytic lesions. The costs were significantly higher in the group in which the fractures occurred versus the group in which early intervention was performed. Early diagnosis of structurally critical lytic lesions around implants by routine follow-up monitoring is recommended for all joint replacement patients.

An evaluation of the potential cost reductions resulting from the use of clodronate in the treatment of metastatic carcinoma of the breast to bone.

The reported studies of clodronate in the management of osteolytic bone metastases suggest a significant palliative role for this drug. In this paper we report on analysis of the hospital costs associated with the management of osteolytic metastatic disease, and an estimate of the potential cost/benefit impact of clodronate therapy. Two separate patient populations were assessed retrospectively. The first, a sample of 120 patients with symptomatic bone metastases who had died from metastatic breast cancer over the period 1980-1990, was used to define the natural history of the disease. A second non-concurrent patient group of 337 patients was evaluated to determine the mean cost of all hospital admissions for patients with bone metastases from breast carcinoma. The length of stay and costs for hospital admissions related to the bone metastases were also assessed, in addition to the cost of out-patient radiation therapy. Our cost/benefit value analysis suggests that there are significant savings to be gained from the use of clodronate if a 20% or greater reduction occurs in the incidence of fractures, hypercalcaemia, and hospital-based treatment for pain control (via radiotherapy). We also speculate that the quality of life of patients with osteolytic bone metastases may be improved with this agent.