The Journal of Arthroplasty, Volume 35, Issue 1, 182 - 187

Comparative Analysis Investigating the Impact of Implant Design on Hospital Length of Stay and Discharge Destination in a Dutch Hospital With an Established Enhanced Recovery Program

Meermans, Geert et al.


Global demand for total knee arthroplasty (TKA) is increasing, driven by an aging and increasingly overweight patient population, culminating in higher healthcare costs. In the Netherlands, the number of TKA surgeries performed annually increased from 21,000 in 2010 to 29,000 in 2017. This study aimed to assess the impact of implant design on hospital length of stay (LOS), surgery time, and discharge destination (home vs a rehabilitation center) in a Dutch hospital with an established enhanced recovery program and short baseline LOS.


A retrospective review of consecutive adult patients who underwent primary TKA in a Dutch hospital between 2015 and 2017 using either the comparator device or the control device.


A total of 200 patients were enrolled in the study (100 per group). Patients who received a comparator device had a significantly shorter LOS (adjusted mean 2.76 days; 95% confidence interval [CI]: 2.45, 3.11) vs the control group (adjusted mean 3.43 days; 95% CI: 3.08, 3.81; P < .01). The proportion of patients discharged to a rehabilitation center, instead of home, was also significantly lower in the comparator device group (adjusted 4.4%; 95% CI: 1.8, 10.7 vs adjusted 11.4%; 95% CI: 6.0, 20.6; P < .05). There was no difference in surgical time between the 2 groups. None of the sensitivity analyses performed affected the original analysis outcome.


This study shows a modest but significant reduction in length of stay and lower rate of discharge to a rehabilitation center in the comparator device group.

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