The Cost-Effectiveness of Platelet-Rich Plasma Compared With Hyaluronic Acid Injections for the Treatment of Knee Osteoarthritis.

PURPOSE: To examine the cost-effectiveness of a series (total of 3 injections) of intra-articular platelet-rich plasma (PRP) injections in comparison to that of hyaluronic acid (HA) viscosupplementation for the treatment of symptomatic knee osteoarthritis. METHODS: Outcome data regarding the use of PRP or HA injections for the treatment of symptomatic knee osteoarthritis were determined from the highest-quality data (Level I) available in the literature until 2015. Health utility values were then derived from these high-quality data. Costs were determined by examining typical charges for patients undergoing a series of either PRP or HA injections for the treatment of this condition at a large private orthopaedic practice. These health utility values and costs were used to create an expected-value decision analysis model. RESULTS: The results of the model revealed that the cost per quality-adjusted life-year (QALY) of a series of PRP injections was $8,635.23/QALY and that of a series of HA injections was $5,331.75/QALY. A series of PRP injections was associated with a higher initial cost than a series of HA injections (difference, $1,433.67); however, PRP was also more effective (higher utility value) than HA by 0.11 QALYs (0.69 vs 0.58, P = .0062) at 1 year. The incremental cost-effectiveness ratio of the use of PRP injections as opposed to HA was $12,628.15/QALY. CONCLUSIONS: Although a series of either PRP ($8,635.23/QALY) or HA ($5,331.75/QALY) injections for the treatment of symptomatic knee osteoarthritis would be considered cost-effective (cost per QALY < $50,000), PRP injections were not more cost-effective than HA injections. However, PRP was significantly more effective at 1 year, and being associated with an incremental cost-effectiveness ratio of $12,628.15/QALY when compared with HA, a series of PRP injections should be considered a reasonable and acceptable alternative to HA injections for the treatment of symptomatic knee osteoarthritis. LEVEL OF EVIDENCE: Level II, economic and decision analysis of Level I studies.

The Cost-Effectiveness of Using Platelet-Rich Plasma During Rotator Cuff Repair: A Markov Model Analysis.

PURPOSE: To perform a cost-utility analysis to determine if the use of platelet-rich plasma (PRP) products during arthroscopic rotator cuff repair (RCR) is cost-effective. METHODS: A cost-utility analysis was conducted using a Markov decision model. Model inputs including health utility values, retear rates, and transition probabilities were derived from the best evidence available in the literature regarding full-thickness rotator cuff tears and their repair, as well as the augmentation of their repair with PRP. Costs were determined by examining the typical patient undergoing treatment for a full-thickness rotator cuff tear in a private orthopaedic clinic and outpatient surgery center. RESULTS: The cost per quality-adjusted life-year ($/QALY) of RCR with and without PRP was $6,775/QALY and $6,612/QALY, respectively. In our base case, the use of PRP to augment RCR was not cost-effective because it had exactly the same "effectiveness" as RCR without PRP augmentation while being associated with a higher cost (additional $750). Sensitivity analysis showed that to achieve a willingness-to-pay threshold of $50,000/QALY, the addition of PRP would need to be associated with a 9.1% reduction in retear rates. If the cost of PRP were increased to $1,000, the retear rate would need to be reduced by 12.1% to reach this same threshold. This compared with a necessary reduction of only 6.1% if the additional cost of PRP was $500. CONCLUSIONS: This cost-utility analysis shows that, currently, the use of PRP to augment RCR is not cost-effective. Sensitivity analysis showed that PRP-augmented repairs would have to show a reduced retear rate of at least 9.1% before the additional cost would be considered cost-effective. LEVEL OF EVIDENCE: Level III, analysis of Level I, II, and III studies.

Fracture of a reverse total shoulder arthroplasty retentive liner.

Reverse shoulder arthroplasty may be indicated in shoulders that cannot be effectively managed by conventional reconstruction procedures. Reported complications include instability, infection, hematoma, scapular notching, and premature component loosening. To our knowledge, however, fracture of a humeral component polyethylene inlay has not been described. A 72-year-old man presented with unstable, painful shoulders after undergoing unsuccessful open repairs and acromioplasties at an outside institution for bilateral massive rotator cuff tears. We performed a left reversed shoulder arthroplasty with a 36-mm glenosphere and a +9-mm polyethylene liner. In the operating room under general anesthesia with chemical paralysis and an interscalene block, his shoulder was stable. The patient required revision with a metal 9-mm lateralizer following an atraumatic dislocation 4 weeks postoperatively. Four weeks following the revision, the patient again presented with a dislocated left shoulder without antecedent trauma. During this second revision, the +6-mm standard polyethylene liner was replaced with a +6-mm lateral retentive polyethylene liner. A third revision surgery was performed after the patient experienced 2 more dislocations with minor activity. Intraoperatively, a fracture of the previously placed +6-mm retentive polyethylene liner was noted. This article may represent a case of dramatic scapular impingement by the humeral components. More subtle forms of scapular notching are common and may suggest significant long-term problems. Many reverse shoulder prostheses are being refined or modified in an attempt to eliminate or reduce the scapular notching phenomenon.