The report, titled, "Improving the Value of Primary Total Knee Arthroplasty: the ATTUNE Knee System," was released during the American Academy of Orthopaedic Surgeons (AAOS) 2017 Annual Meeting this week in San Diego, Calif. It was authored by David Fisher, M.D., director of the Total Joint Center of Excellence at OrthoIndy Hospital in Indianapolis, Ind., and Professor David Parkin, an honorary Visiting Professor at City University of London and a Senior Visiting Fellow, Office of Health Economics.
The report analyzes approaches for evaluating primary total knee arthroplasty (TKA) from a clinical and health economic perspective, and assesses the current data from DePuy Synthes’ ATTUNE Knee Evidence Generation Program. This program, the largest of its kind in DePuy Synthes’ history, includes a wide range of data from company-initiated studies, investigator-initiated studies, independent studies and national joint registries.
"ATTUNE is our flagship brand, and the company has made an enormous investment in the [product] platform. If you look at the economic value evidence and the patient outcomes evidence, the story so far is ATTUNE has delivered on its promise," Liam Rowley, DePuy Synthes worldwide product development director for knees, told Orthopedic Design & Technology during an interview at AAOS. " We believe that the data we have proves that the implant makes the difference."
In their analysis, Fisher and Parkin concluded that, "Based on available data, the ATTUNE Knee appears to be advancing outcomes for patients and creating value for clinicians, providers and payors in a challenging and dynamic healthcare environment."
The report comes at a time when the entire episode of patient care is a major focus for global healthcare providers, placing a laser-like focus on both improving patient outcomes and managing costs. The bundled payments program in the United States and the "Payments for Results" system in England are two examples of the drive to minimize the total cost of care while maintaining quality. Against this backdrop, data from a comprehensive evidence generation program can help provide evidence to support decisions about a device’s overall value.
"The success of any knee replacement is multifactorial, and the data on the ATTUNE Knee gives me confidence that I’m using a knee replacement that is delivering value for patients and the healthcare system," said Fisher.
Added Parkin: "Quality of life, as measured by patient reported outcomes, has been shown to be a driver of cost effectiveness in knee replacement. The evidence that I’ve seen about the effectiveness of the ATTUNE Knee in improving patient reported outcomes suggests it can deliver a better quality of life for patients compared to other leading knee systems. Therefore, the ATTUNE Knee may potentially play a role in helping reduce some of the healthcare and societal costs associated with knee osteoarthritis."
According to the analysis, the ATTUNE Knee has thus far demonstrated favorable survivorship, improved patient reported outcomes versus other knee systems, as well as potential economic benefits:
- Survivorship: The published report from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) showed that the ATTUNE Knee’s estimated cumulative percent revision was 1.39 percent at three years (98.61 percent survivorship) for 4,463 knees, comparing favorably to the class of Cemented Total Knee Arthroplasty that has an estimated cumulative percent revision of 1.50 percent.1 In addition, per the 2016 Australian Orthopaedic Associati on National Joint Replacement Registry (AOANJRR), in which 4,831 ATTUNE Knees are being tracked, the ATTUNE Knee’s estimated cumulative percent revision was 0.5 percent (ATTUNE Cruciate Retaining Knee) and 0.4 percent (ATTUNE Posterior Stabilized Knee) at one year.2 This compares favorably to the overall class of cemented TKA at one year, which has an estimated cumulative percent revision of 1 percent.2
- Patient Reported Outcomes: DePuy Synthes has taken the lead in this area by helping generate and validate a new measure, the Patient’s Knee Implant Performance (PKIP), to specifically assess the functional status of a patient’s knee from their own perspective. Results of a study using PKIP as well as other commonly used generic and condition-specific patient reported outcome measures showed that, at one year, study participants implanted with the ATTUNE Knee had statistically significant improvements compared to other leading knee systems in terms of confidence in stability during activity, decreased anterior knee pain, activities of daily living and quality of life.3
- Health Economics: A U.S. hospital database analysis showed 39 percent lower odds of patient discharge to a skilled nursing facility when implanted with an ATTUNE Knee, compared to patients who received total knee replacement with a Triathlon Knee.4 This may potentially impact patient satisfaction and reduce healthcare costs. Post discharge costsare a significant portion of the overall episode of care. One study showed that up to 35 percent of episodic costs were related to post hospital discharge care5 and another showed it was up to 50 percent.6
DePuy Synthes Companies, part of the Johnson & Johnson Family of Companies, provides a comprehensive orthopedics portfolios, offering solutions in such specialties as joint reconstruction, trauma, craniomaxillofacial, spinal surgery, and sports medicine.
1. National Joint Registry for England, Wales, Northern Ireland and the Isle of Man, 13th Annual Report. (2016). Table 3.24 (a). Available from: www.njrreports.org.uk
2. Australian Orthopaedic Association National Joint Replacement Registry Annual Report. (2016). Tables KT9 and KT22. Retrieved from: https://aoanjrr.sahmri.com/documents/10180/275066/Hip%2C%20Knee%20%26%20Shoulder%20Arthroplasty
3. Hamilton WG, Brenkel I, Clatworthy M, Dwyer K, Himden S, Lesko J, Kantor S. Early Patient-Reported Outcomes With Primary vs Contemporary Total Knee Arthroplasty: A Comparison of Two Worldwide Multi-Center Prospective Studies. Presentation at the International Society for Technology in Arthroplasty (ISTA), Boston, MA Oct. 2016. Poster Presentation & E-Poster 0060.
4. Etter K, Lerner J, Moor C, Yoo A, Kalsekar I. (2016). PMD10-Comparative Effectiveness of ATTUNE Versus Triathlon Total Knee Systems: Real-World Length of Stay and Discharge Status. Value in Health 19(3): A298. Premiere Perspective Database analysis including 38 hospitals, representing 1,178 primary, unilateral TKAs with the ATTUNE Knee and 5,707 primary, unilateral TKAs with Triathlon. The analysis found the patients implanted with the ATTUNE Knee had statistically shorter length of stay and were more frequently discharged home vs. a skilled nursing facility compared to the TKAs with Triathlon.
5. Bozic KJ, Ward L, Vail TP, Maze M, Bundled payments in total joint arthroplasty: targeting opportunities for quality improvement and cost reduction. Clin Orthop Relat Res 2014;472:188-93.
6. Department of Health and Human Services. Centers for Medicare & Medicaid Services. 42 CFR Part 510. [CMS-5516-f], Medicare Program; Comprehensive Care for Joint Replacement Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement, www.gpo.gov/fdsys/pkg/FR-2015-11-24/pdf/2015-29438.pdf, last accessed 2-10-2017.