Silk Dressings Are More Cost Effective Than 2-Octyl Cyanoacrylate Mesh in Hip and Knee Arthroplasty

INTRODUCTION: Wound complications are costly after primary and revision total hip and knee arthroplasty (TJA). Mesh with 2-octyl cyanoacrylate can perform well but is associated with hypersensitivity and wound-healing complications. Silk dressings have shown fewer adverse events. We compared dressing costs, examining direct and complication-related expenses. METHODS: An IRB-exempt cost-effectiveness analysis was conducted using published data on complication rates, including hypersensitivity reactions, delayed wound healing, periprosthetic joint infection (PJI), and application times. Direct material costs were calculated and annualized using the manufacturer's suggested retail prices (MSRPs) and bulk-purchase rates. Indirect costs were calculated for surgical costs per minute and treatment of wound complications and PJI. RESULTS: Direct material costs were $387 (MSRP) or $79 (bulk pricing) for mesh dressings versus $120 (MSRP) or $60 (bulk pricing) for silk. When application times, differential rates of sensitivity reactions, and wound complications and their management are applied to national TJA rates, mesh costs markedly more than silk by $939/patient (MSRP) and $690/patient (bulk pricing) (MSRP: $1,090 versus $151/patient; $1.89 billion versus $2.62 million/annum; bulk pricing: $781 versus $91/patient; $1.36 billion versus $158 million/annum). Excluding PJI, which has a relationship that is several degrees away from dressing type, mesh was still more expensive than silk by $484/patient (MSRP) and $235/patient (bulk pricing) (MSRP: $634/patient versus $150; $1.1 billion versus $262 million/annum; bulk pricing: $326/patient versus $91; $566 million vs. $158 million/annum). CONCLUSION: Silk dressings are more cost-effective than mesh dressings because of shorter application time, fewer complications, and lower pricing. For clinical and economic reasons, silk dressings should be considered for TJA.