(SLC-009) Hospital Healthcare Resource Utilization and 12-Month Outcomes Following Total Hip Arthroplasty with ACTIS™ Hip System

Background: The ACTIS™ Hip System, a cementless, medial collared, triple tapered hip system from Johnson & Johnson Orthopaedic was launched in the US in 2016. Early performance data have shown it to be best in class.

Objectives: This study was designed to evaluate differences in healthcare resource utilization and hospital costs, among patients who underwent total hip arthroplasty (THA) with ACTIS compared to the Accolade® II Femoral Hip System from Stryker.

Methods: The PINC AI Healthcare Database (containing >1000 hospitals) was used for analysis. Patients >21 years of age who underwent cementless THA from January 2016 to September 2023implanted with ACTIS or Accolade II were identified. Primary outcomes included length of hospital stay and 90-day all-cause readmission. Secondary outcomes included rates of hip revision, all-cause and hip related readmission, and hip-related complications within 90- and 365-days post-procedure. The exposure was the device type (ACTIS vs. Accolade II). Study covariates included patient demographics, insurance type, comorbidities, and hospital characteristics. Surgical approach could not be identified and is a limitation to the study. Cohorts were balanced using 3 propensity score methods (matching, stratification and covariate balance propensity score (CBPS)) and the best balancing method was chosen using average standardized mean difference (SMD), variables with SMD ≥ 0.2 and samples retained. Generalized linear modeling was used to estimate outcomes and 95% confidence intervals on the balanced cohorts.

Results: 14,238 ACTIS and 17,578 Accolade II patients were included. CBPS method led to best balance. Balanced cohorts had an average age of 66 years, 57% female, and 57% Medicare recipients. Length of stay was significantly shorter for ACTIS (1.65 days vs. 1.93 days for control, p-value < 0.01). The 90-day all-cause readmission rate was significantly lower for ACTIS (2.62%) versus Accolade II (3.15%) (p-value < 0.01, risk difference = 0.52% [0.13 to 0.93]. The 365-day all-cause readmission was also significantly lower for ACTIS (6.28% vs. 7.46%, difference: 1.19% [0.53 to 1.84%], p-value < 0.01). Total care cost care over 365-days was lower for ACTIS vs Accolade II cohort ($18,514 vs $18,742). The revision rate was also lower for ACTIS (0.04%) compared to Accolade II (0.16%) with a difference of 0.12% [0.05 – 0.19] at 365-day follow-up.

Conclusions: Comparative analyses suggested shorter length of stay and fewer all-cause readmissions and revision within 365-days post-procedure for ACTIS compared to Accolade II, which offers potential economic benefits to healthcare systems.