Motion-Restoring Surgery versus Non-Operative Stretch-Assist Devices for Treatment of Joint Contracture: Utilization, Timing, Cost, and Outcomes from Medicare and Commercial Claims

Background This study aimed to assess national treatment patterns, timing, and costs of interventions for joint contracture using Medicare and commercial claims data. Emphasis was placed on comparing the frequency, cost, and recovery outcomes associated with continuous passive motion (CPM), motion-restoring surgery (MRS), and wearable stretch-assist devices, including dynamic and turnbuckle/wormgear stretch-assist splints. Methods A retrospective cohort analysis of the Centers for Medicare & Medicaid Services (CMS) and IBM MarketScan databases (2015–2018) was conducted. Patients diagnosed with contracture of the knee, shoulder, elbow, wrist, or ankle were identified through medical diagnosis codes. Incidence, prescriptive patterns, recovery time, and costs were determined using corresponding claims-based information. Recovery duration was defined as the time from index treatment to the last rehabilitation claim. Comparative analyses were conducted using the Wilcoxon Signed-Rank and Mood’s Median tests. Results MRS was the predominant treatment across all joints and accounted for the majority of costs associated with contracture care. Across joints, MRS-treated patients experienced significantly higher total costs and longer recovery durations, with an average 234-day delay relative to non-operative care. Wearable dynamic and turnbuckle/wormgear splints were prescribed in fewer than 8% of cases and were typically initiated months after primary surgery and often following MRS. CPM demonstrated no measurable benefit in recovery or prevention of contracture and was associated with higher costs. Only dynamic splint use after elbow fracture was associated with significantly shorter recovery compared to MRS. Conclusions Current clinical practice heavily favors MRS despite prolonged recovery and higher expenses. Non-operative mechanical stretch-assist devices are underutilized and typically prescribed too late to influence outcomes suggesting that the healthcare community does not consider them a viable option. The greater adoption of elbow splints may reflect providers' reluctance to use elbow MRS.