Remplissage During Primary Arthroscopic Bankart Repair Is Highly Cost-Effective for Off-Track Hill-Sachs Lesions and Variably Cost-Effective for On-Track Hill-Sachs Lesions With Glenoid Bone Loss Below 15.

PURPOSE: To assess the cost-effectiveness of performing a remplissage procedure 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, and revision surgery, as well as 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 (<15%). The initial failure rate was defined as the rate of revision surgery for shoulder redislocation. Break-even economic analysis was used to assess the cost-effectiveness of adding remplissage to a primary ALR. To account for the variability in costs and initial failure rates, in addition to procedural differences, across institutions, a wide range of values were used to calculate the absolute risk reduction and number needed to treat to achieve cost-effectiveness. To provide alternate scenarios, sub-analyses with revision remplissage and revision Latarjet procedures were also performed.

RESULTS

Primary remplissage is cost-effective for off-track HSLs if it prevents 1 revision for every 15 primary ALRs (absolute risk reduction, 6.8%; number needed to treat, 15), assuming primary remplissage costs of $982 and revision surgery costs of $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 the revision Latarjet procedure similarly showed 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.

LEVEL OF EVIDENCE: Level IV, economic analysis.