Gabriella Schreiner, Stephen Fucaloro, Madison Hayes-Lattin, Jack Bragg, Matthew Salzler
{"title":"在初级关节镜下Bankart修复期间进行翻修对于正常的Hill-Sachs病变具有很高的成本效益，对于关节盂骨丢失低于15的偏离轨道的Hill-Sachs病变具有不同的成本效益。","authors":"Gabriella Schreiner, Stephen Fucaloro, Madison Hayes-Lattin, Jack Bragg, Matthew Salzler","doi":"10.1016/j.arthro.2025.06.021","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to assess the cost-effectiveness of performing a remplissage at the time of primary arthroscopic labral repair (ALR) for shoulder dislocations with on- and off-track Hill-Sachs Lesions (HSLs).</p><p><strong>Methods: </strong>Baseline costs for ALR, remplissage, revision surgery, and initial failure rate were collected from the literature for both on- and off-track HSLs. All referenced studies included patients with subcritical glenoid bone loss less than 15%. The initial failure rate was defined as the rate of revision surgery for shoulder re-dislocation. Break-even economic analysis was used to assess the cost-effectiveness of adding remplissage to a primary ALR. To account for the variability in the cost, initial failure rates, and procedural differences across institutions, a wide range of values were used to calculate the absolute risk reduction (ARR) and number needed to treat (NNT) to achieve cost-effectiveness. To provide alternate scenarios, sub-analyses with revision remplissage and revision latarjet were also performed.</p><p><strong>Results: </strong>Primary remplissage was cost-effective for off-track HSLs if it prevents one revision for every 15 primary ALRs (ARR 6.8%, NNT=15), assuming primary remplissage costs of $982 and revision surgery costs $14,498. With an initial failure rate of 14.0%, primary remplissage is cost-effective for off-track HSLs when the cost of revision surgery exceeds $7,000 or when primary remplissage costs less than $2,750. For on-track lesions, remplissage is cost-effective at revision surgery costs exceeding $9,632 or when remplissage costs less than $2,000. Sub-analysis of revision latarjet similarly demonstrated cost-effectiveness.</p><p><strong>Conclusions: </strong>Remplissage is a highly cost-effective intervention for off-track HSLs for a wide range of primary and revision surgery costs according to this break-even economic analysis. Remplissage is cost-effective for on-track lesions when the cost of revision surgery is greater than $9,632 or when remplissage costs less than $2,000.</p><p><strong>Level of evidence: </strong>IV, economic analysis.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4000,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Remplissage During Primary Arthroscopic Bankart Repair is Highly Cost-Effective for On-Track Hill-Sachs Lesions and Variably Cost-Effective for Off-Track Hill-Sachs Lesions with Glenoid Bone Loss Below 15.\",\"authors\":\"Gabriella Schreiner, Stephen Fucaloro, Madison Hayes-Lattin, Jack Bragg, Matthew Salzler\",\"doi\":\"10.1016/j.arthro.2025.06.021\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>The purpose of this study is to assess the cost-effectiveness of performing a remplissage at the time of primary arthroscopic labral repair (ALR) for shoulder dislocations with on- and off-track Hill-Sachs Lesions (HSLs).</p><p><strong>Methods: </strong>Baseline costs for ALR, remplissage, revision surgery, and initial failure rate were collected from the literature for both on- and off-track HSLs. All referenced studies included patients with subcritical glenoid bone loss less than 15%. The initial failure rate was defined as the rate of revision surgery for shoulder re-dislocation. Break-even economic analysis was used to assess the cost-effectiveness of adding remplissage to a primary ALR. To account for the variability in the cost, initial failure rates, and procedural differences across institutions, a wide range of values were used to calculate the absolute risk reduction (ARR) and number needed to treat (NNT) to achieve cost-effectiveness. To provide alternate scenarios, sub-analyses with revision remplissage and revision latarjet were also performed.</p><p><strong>Results: </strong>Primary remplissage was cost-effective for off-track HSLs if it prevents one revision for every 15 primary ALRs (ARR 6.8%, NNT=15), assuming primary remplissage costs of $982 and revision surgery costs $14,498. With an initial failure rate of 14.0%, primary remplissage is cost-effective for off-track HSLs when the cost of revision surgery exceeds $7,000 or when primary remplissage costs less than $2,750. For on-track lesions, remplissage is cost-effective at revision surgery costs exceeding $9,632 or when remplissage costs less than $2,000. Sub-analysis of revision latarjet similarly demonstrated cost-effectiveness.</p><p><strong>Conclusions: </strong>Remplissage is a highly cost-effective intervention for off-track HSLs for a wide range of primary and revision surgery costs according to this break-even economic analysis. Remplissage is cost-effective for on-track lesions when the cost of revision surgery is greater than $9,632 or when remplissage costs less than $2,000.</p><p><strong>Level of evidence: </strong>IV, economic analysis.</p>\",\"PeriodicalId\":55459,\"journal\":{\"name\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2025-07-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.arthro.2025.06.021\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.arthro.2025.06.021","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Remplissage During Primary Arthroscopic Bankart Repair is Highly Cost-Effective for On-Track Hill-Sachs Lesions and Variably Cost-Effective for Off-Track Hill-Sachs Lesions with Glenoid Bone Loss Below 15.
Purpose: The purpose of this study is to assess the cost-effectiveness of performing a remplissage at the time of primary arthroscopic labral repair (ALR) for shoulder dislocations with on- and off-track Hill-Sachs Lesions (HSLs).
Methods: Baseline costs for ALR, remplissage, revision surgery, and initial failure rate were collected from the literature for both on- and off-track HSLs. All referenced studies included patients with subcritical glenoid bone loss less than 15%. The initial failure rate was defined as the rate of revision surgery for shoulder re-dislocation. Break-even economic analysis was used to assess the cost-effectiveness of adding remplissage to a primary ALR. To account for the variability in the cost, initial failure rates, and procedural differences across institutions, a wide range of values were used to calculate the absolute risk reduction (ARR) and number needed to treat (NNT) to achieve cost-effectiveness. To provide alternate scenarios, sub-analyses with revision remplissage and revision latarjet were also performed.
Results: Primary remplissage was cost-effective for off-track HSLs if it prevents one revision for every 15 primary ALRs (ARR 6.8%, NNT=15), assuming primary remplissage costs of $982 and revision surgery costs $14,498. With an initial failure rate of 14.0%, primary remplissage is cost-effective for off-track HSLs when the cost of revision surgery exceeds $7,000 or when primary remplissage costs less than $2,750. For on-track lesions, remplissage is cost-effective at revision surgery costs exceeding $9,632 or when remplissage costs less than $2,000. Sub-analysis of revision latarjet similarly demonstrated cost-effectiveness.
Conclusions: Remplissage is a highly cost-effective intervention for off-track HSLs for a wide range of primary and revision surgery costs according to this break-even economic analysis. Remplissage is cost-effective for on-track lesions when the cost of revision surgery is greater than $9,632 or when remplissage costs less than $2,000.
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Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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