A Retrospective Review of Reimbursement in Revision Total Hip Arthroplasty: A Disparity Between Case Complexity and RVU Compensation

Compensation Crisis: The Impact of Inflation and Declining Medicare Payments on Hip Arthroplasty Surgeons

INTRODUCTION

Despite advances in total hip arthroplasty (THA) and revision THA (rTHA), declining reimbursement rates for orthopaedic surgeons threaten financial sustainability, particularly as case complexity and demand rise. This analysis focused on changes in Medicare payments from 2006 to 2022, adjusted for inflation, to assess trends in surgeon compensation and their implications.

METHODS

Data were extracted from 2006 to 2022, utilizing Current Procedural Terminology (CPT) codes for primary THA and rTHA to assess case complexity. Medicare's Relative Value Unit (RVU) conversion factors and reimbursement rates were analyzed and adjusted for inflation using the Consumer Price Index. Key metrics, including average reimbursement per case and per minute, were calculated, along with Total Percentage Change and Compound Annual Growth Rate (CAGR). Projected reimbursement rates for 2030 were also estimated.

RESULTS

Reimbursement rates for THA procedures have considerably declined in inflation-adjusted terms since 2006. Medicare reimbursement per work Relative Value Unit (wRVU) decreased by 38%, and all five CPT codes studied exhibited negative CAGR. By 2022, average reimbursements for primary THA and rTHA had dropped by 39.69 and 34.28%, respectively. On the other hand, the hospital share of Medicare payments has increased disproportionately compared to surgeon compensation, reflecting a trend toward reduced reimbursement for surgeon effort, complexity, and time.

DISCUSSION

The findings highlight a growing disparity in surgeon compensation despite increased patient demand and procedure complexity. Declining reimbursement pressures surgeons to increase productivity and efficiency, potentially leading to higher burnout rates and reduced willingness to perform revision cases. Medicare's failure to incorporate inflation adjustments for physician payments exacerbates this issue. As the field shifts toward value-based care, addressing surgeon reimbursement is critical to sustaining high-quality patient outcomes and fair compensation.

Periprosthetic Joint Infection Centers of Excellence: Moonshot or Misstep? A Survey of the American Association of Hip and Knee Surgeons Members

BACKGROUND

Periprosthetic joint infection (PJI) centers of excellence (COEs) have been discussed as an innovative model to improve health care quality and value in treating PJI. A national network of regional PJI centers may have the ability to improve patient outcomes, standardize treatment protocols, accelerate research, and provide economies of scale while caring for this patient population with complex needs. This study surveyed perceptions toward establishing a PJI COE among members of the American Association of Hip and Knee Surgeons (AAHKS).

METHODS

A 16-question survey was approved by the AAHKS Advocacy Committee and distributed to all 2,529 fellow-level members of AAHKS. Study results were analyzed using descriptive statistics. There were 626 survey responses (24.8% response rate).

RESULTS

More than two-thirds of survey participants (69%) reported that they would consider participation in some form of PJI COE. Most surgeons believe managing PJI is a cost to their hospital system. The top concern among respondents was that PJI COE may become a "dumping ground" for inappropriate referrals. Participants reported financial concerns regarding the possibility that establishing such a program may trigger a reevaluation of reimbursement for primary total joint arthroplasty procedures.

CONCLUSIONS

Although primary total joint arthroplasty is a target of national health care cost containment efforts, PJI is yet to be addressed. This gives AAHKS the opportunity to prospectively advocate for reform. A PJI COE designed to perform a high volume of infection revision procedures may be advantageous in providing the specialized and longitudinal care required by PJI patients. The AAHKS surgeons expressed interest and reservations in the establishment of PJI COEs that can inform future policy.

Patient Health Care Disparities in Shoulder Arthroplasty

PURPOSE OF REVIEW

Shoulder arthroplasty (SA) is an effective surgical procedure to treat advanced degenerative conditions of the shoulder as well as tumors or fractures of the proximal humerus. Utilization of SA is increasing in the United States as indications have expanded, however, health care disparities around utilization and clinical outcomes following SA also exist. This review examines current literature on patient related health care disparities in SA.

RECENT FINDINGS

Within SA, patient related health care disparities are highly influenced by race, ethnicity, socioeconomic status, geography, and patient sex. Short term clinical outcomes show that Non-White patients experience lower utilization of SA, longer hospital stays, higher complications, and increased readmissions. Sex related disparities demonstrate that female patients have a longer interval between initial consultation and surgery. Additionally, females experience lower functional scores and higher rates of perioperative fractures than males. In the current era of value-based care, wide disparities in early postoperative outcomes increase the cost of healthcare to both patients and health systems. Disparities in SA remain underexplored compared to other health topics. Existing literature highlights suboptimal outcomes in racially, ethnically, or socially disadvantaged groups. Active awareness and recognition of healthcare disparities are required to renew and strengthen initiatives to deliver more equitable care after SA.

Health Disparities in Aseptic Revision Total Hip Arthroplasty: Assessing the Impact of Social Determinants of Health

BACKGROUND

Social determinants of health (SDOH) have been shown to reliably predict outcomes in patients undergoing orthopaedic procedures. However, there remains a paucity of data in the literature on whether SDOH can predict adverse outcomes in those undergoing aseptic revision total hip arthroplasty (rTHA). We aimed to examine the relationship between SDOH and clinical outcomes in aseptic rTHA.

METHODS

This retrospective study identified 843 patients undergoing aseptic rTHA using an institutional joint registry. Data on demographics, length of stay, 90-day complications, discharge disposition, and re-revisions were recorded. The Area Deprivation Index (ADI) and four subscales of the Social Vulnerability Index (SVI) were identified using census tract codes. High vulnerability to SDOH was defined as the top quartile for ADI and each SVI category. A multivariate regression was performed to identify risk factors for worse clinical outcomes.

RESULTS

Patients who had a higher ADI (43.2 versus 22.6%, P < 0.001) and SVI (32.9 versus 22.9%, P = 0.011) were revised for aseptic loosening at a higher proportion compared to their counterparts. Additionally, a lower prevalence of osteolysis was observed in patients who had a high ADI compared to those who had a low ADI (3.7 versus 10.6%, P = 0.048). In multivariate analyses, a high overall SVI was an independent risk factor for mortality (odds ratio [OR] = 2.40, P = 0.020). A higher household SVI was associated with increased mortality (OR = 2.13, P = 0.038) and reoperations (OR = 1.89, P = 0.039). Similarly, patients who had high housing and transportation SVI had higher odds of 90-day complications (OR = 1.66, P = 0.045) and PJI episodes (OR = 2.33, P = 0.028).

CONCLUSIONS

Patients who had higher levels of deprivation exhibited different surgical indications and poorer clinical outcomes following aseptic rTHA. Our findings suggest that SVI is an effective tool for assessing SDOH.

Comparison of RVU Reimbursement in Anterior or Posterior Approach for Single- and Multilevel Cervical Spinal Fusion

STUDY DESIGN

Retrospective database study.

OBJECTIVE

This study aims to quantify and compare mean work RVUs (wRVUs), mean operative time (OpTime), and wRVUs/min in single- and multilevel anterior and posterior cervical spine fusions performed between 2011 and 2020.

SUMMARY OF BACKGROUND DATA

Prior research has demonstrated inconsistencies in technical skill, operative time, and surgical difficulty with reimbursement in various orthopedic subspecialties. Although trends investigating physician effort and reimbursement have been investigated in lumbar spine surgery, less research has examined these relationships with respect to cervical spine procedures.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was queried for Current Procedural Terminology (CPT) codes reflecting anterior cervical discectomy and fusion (ACDF), posterior cervical decompression and fusion (PCDF), and the number of levels involved. The cohort was stratified into 10 groups: single-level, 2-level, 3-level, 4-level, 5+ level anterior or posterior cervical fusions. Mean operative times, mean wRVUs, and wRVU/min were calculated and compared by Student t test.

RESULTS

A total of 100,997 patients met inclusion criteria in this study, of which 79,141 (78.36%) underwent ACDF, whereas 21,836 (21.62%) underwent PCDF. One- and 2-level fusions were most common in both ACDF and PCDF. In 1-, 3-, 4-, and 5+ level fusion, the anterior approach demonstrated significantly lower mean wRVU ( P <0.001). In 1-, 2-, and 3-level fusions, the anterior approach had significantly lower operation times ( P <0.001). The anterior approach demonstrated significantly higher wRVU/min in 1- and 2- levels ( P <0.001) but lower wRVU/min in 3- and 4-level fusions ( P <0.001).

CONCLUSIONS

Clear discrepancies exist between surgical approach and levels of fusion in cervical spine procedures incongruous with markers of surgical difficulty, physician effort, or expertise required. These specific results suggest that the complexity of multi-level anterior cervical fusions are not effectively accounted for by existing RVU measures.

Establishing a Per-Hour Rate for Early-Career Adult Reconstruction Surgeons Performing Medicare Primary Total Joint Arthroplasty

Background

There is a paucity of data regarding compensation for early-career adult reconstruction surgeons. This study aims to quantify the time throughout the full episode of care for a Medicare primary total hip/knee arthroplasty and convert to per-hour pay for early-career arthroplasty surgeons at various geographic locations and practice settings. Using Center for Medicare and Medicaid Services data, this study also compares the compensation of early-career vs established total joint arthroplasty (TJA) surgeons.

Methods

Between January 2022 and January 2023, 3 early-career surgeons in 3 different locations collected prospective data on time spent in patient care during the global period following primary TJAs (pTJAs). A weighted average time spent per pTJA during global period was calculated with the 2024 work relative value unit and conversion factor to establish a per-hour rate. This rate was compared to the compensation rates of other healthcare-related fields and established TJA surgeons using Relative Value Scale Update Committee (RUC) values.

Results

A total of 334 pTJAs (148 hips and 186 knees) were performed among 3 surgeons, and per-hour rates of $87.62 and $87.70 were found, respectively. These are less than hospital/healthcare system/health insurance/med tech CEOs, lawyers, dentists, and travel nurses. Early-career TJA surgeons were found to take 7.98%-8.68% longer than RUC standard times for a TJA episode of care.

Conclusions

This study quantifies the per-hour compensation of early-career arthroplasty surgeons, who earn lower compensation rates to travel nurses and take longer than Center for Medicare and Medicaid Services RUC times for pTJAs. Given the increasing demand for pTJAs, decreasing reimbursement rates, and concern over burnout, access to quality pTJA care for patients is concerning.

Revision Arthroplasty Among Medicare Patients in the United States - Arthroplasty Surgeons are Doing More for Less

BACKGROUND

Previously documented trends of major joint arthroplasty demonstrate increasing volume and decreasing reimbursement for primary total knee and total hip arthroplasty procedures. As such, the purpose of this study was to evaluate trends in revision knee and hip arthroplasty volume and true Medicare reimbursements to physicians.

METHODS

The publicly accessible Centers for Medicare and Medicaid files were evaluated. Data were retrieved from the Part B National Summary Data File and queried for revision knee and hip arthroplasty billed to Medicare from 2000 to 2021. The total charge submitted to Medicare, Medicare reimbursement, number of revision arthroplasty surgeries performed, and average reimbursement per surgery were collected for each year. All monetary data were adjusted for inflation to 2021 dollars.

RESULTS

There were 492,360 revision total knee arthroplasty surgeries and 424,163 revision hip arthroplasty procedures billed to Medicare from 2000 to 2021. Medicare was billed a total of $919,603,674.86 for revision knee and $862,979,761.57 for revision hip arthroplasty during that time. Medicare reimbursed physicians an average of $1,499.89 per knee revision and $1,603.32 per hip revision surgery. The total volume of revision knee arthroplasty increased by 9,380 (62%) and revision hip decreased by 1,743 (9%) from the year 2000 to 2021. However, there was a decrease of average reimbursement per procedure of more than 37% ($1,987.14 to 1,254) and 39% ($2,149.87 to 1,311.17), respectively.

CONCLUSIONS

Despite a notable increase in the volume of revision total knee and stagnant revision hip arthroplasty, total billings to and reimbursements from Medicare for these procedures have not changed markedly per year. Importantly, this means that physicians are conducting more of these high-impact procedures yearly, while being reimbursed per procedure at a declining rate. This may indicate a need to re-assess billing and reimbursement rates for revision arthroplasty, in the context of the ever-increasing inflation rate.

The Trend of Medicare Reimbursement for Total Joint Arthroplasty: Using Mathematical Models to Predict Possible Per-Hour Rate Out to 2030

Background

While multiple studies have assessed the trends of Medicare reimbursement for orthopedic total joint arthroplasty (TJA) surgeries, none have forecasted reimbursement in relatable per-hour figures. The purposes of this study are to examine trends of reimbursement for primary and revision TJA and translate forecasted primary TJA reimbursement to relatable per-hour compensation.

Methods

The Center for Medicare and Medicaid Services reimbursement data from 1992 to 2024 were used to create a historical view of reimbursement for primary and revision TJA. All monetary values were converted to 2023 USD to account for inflation. Polynomial and linear forecast equations were used to predict the future of the TJA reimbursement to 2030. Relative Value Scale Update Committee standard times for procedures were used with the forecasts to establish per-hour rates.

Results

Total reimbursement for primary total hip arthroplasty/total knee arthroplasty is forecasted to decrease 85.36%/86.14% by 2030. Using prior trends in reimbursement, TJA procedures are predicted to reimburse at or less than $100.00 2023 USD per Medicare case by 2030. Moreover, TJA surgeons are forecasted to earn $13.93/h per primary total hip arthroplasty and $14.97/h per primary total knee arthroplasty by 2030.

Conclusions

This study highlights the concerning trends for both primary and revision arthroplasties as TJA surgeons are on a path to earn below minimum wage for primary TJAs by 2030. Mathematical models forecast a bleak future for orthopedic TJA reimbursement. This downward trajectory poses a risk to access and quality of care.

Complications of periprosthetic fracture revision vs aseptic revision of total knee arthroplasty

Background

Periprosthetic fractures after total knee arthroplasty (TKA) are a challenging problem due to complex fracture patterns, poor bone quality, and a high-risk patient population. Treatment of both periprosthetic fractures and aseptic complications can include revision TKA. In this study, we compared systemic and orthopaedic complications following periprosthetic fracture associated revision TKA to aseptic revision TKA.

Methods

This is a retrospective cohort study using data from the years 2010-2020 from a national administrative claims database. Billing codes were used to identify revision TKAs with a diagnosis of periprosthetic fracture or aseptic complications (loosening, dislocation, arthrofibrosis, osteolysis, or prosthetic wear) within one year prior to revision. Pertinent systemic complications and rates of repeat revision TKA, periprosthetic infection, and repeat fractures were compared between the two groups.

Results

We identified 9891 periprosthetic fracture associated revision TKAs and 47,071 aseptic revision TKAs. Our study found higher rate of systemic complications including AKI, DVT, wound disruption, hematoma, and surgical site infections in periprosthetic fracture associated revision TKA compared to aseptic revision TKA. Furthermore, we found higher rates of repeat revision TKA, periprosthetic infections, and repeat periprosthetic fractures in fracture associated revision TKA group compared to aseptic revision group.

Conclusions

Our work highlights the significant short- and long-term complications associated with periprosthetic fracture associated revision TKA. Future working comparing functional outcomes and optimal surgical techniques are needed.

Revision Total Joint Arthroplasty Places a Disproportionate Burden on Surgeons: A Comparison Using the National Aeronautics and Space Administration Task Load Index (NASA TLX)

BACKGROUND

Perceived surgeon workload of performing primary and revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) is challenging to quantify. The National Aeronautics and Space Administration Task Load Index (NASA TLX) survey was developed to quantify experiences following aviation and has been applied to healthcare fields. Our purposes were to 1) quantify the workload endured by surgeons who are performing primary and revision TKA and THA and 2) compare these values to their Center for Medicare & Medicaid Services (CMS) reimbursement.

METHODS

A prospective cohort of 5 fellowship-trained adult reconstruction surgeons completed NASA TLX surveys following primary and revision TKA/THA cases. A total of 122 surveys consisting of 70 TKA (48 primaries and 22 revisions) and 55 THA surveys (38 primaries and 17 revisions) were completed. Patient demographics and surgical variables were recorded. Final NASA TLX workloads were compared to 2021 CMS work relative value units.

RESULTS

Compared to primary TKA, revision TKA had 176% increased intraoperative workload (P < .001), 233% increased mental burden (P < .001), and 150% increased physical burden (P < .001). Compared to primary THA, revision THA had 106% increased intraoperative workload (P < .001), 96% increased mental burden (P < .001), and 91% increased physical burden (P < .001). Operative time was higher in revision versus primary TKA (118 versus 84.5 minutes, P = .05) and THA (150 versus 115 minutes, P = .001). Based upon 2021 CMS data, revision TKA and THA would need to be compensated by an additional 36% and 12.3%, respectively, to parallel intraoperative efforts.

CONCLUSIONS

Revision hip and knee arthroplasty places a major mental and physical workload upon surgeons and is disproportionately compensated by CMS.

Validation of a Classification System for Optimal Application of Debridement, Antibiotics, and Implant Retention in Prosthetic Joint Infections following Total Knee Arthroplasty: A Retrospective Review

INTRODUCTION

Periprosthetic joint infection (PJI) remains a serious complication after total knee arthroplasty (TKA). While debridement, antibiotics, and implant retention (DAIR) are considered for acute PJI, success rates vary. This study aims to assess a new scoring system's accuracy in predicting DAIR success.

METHODS

119 TKA patients (2008-2019) diagnosed with PJI who underwent DAIR were included for analysis. Data were collected on demographics, laboratory values, and clinical outcomes. This was used for validation of the novel classification system consisting of PJI acuteness, microorganism classification, and host health for DAIR indication. Statistical analysis was carried out using SPSS programming.

RESULTS

Mean follow-up was 2.5 years with an average age of 65.5 ± 9.1 years, BMI of 31.9 ± 6.2 kg/m2, and CCI of 3.04 ± 1.8. Successful infection eradication occurred in 75.6% of patients. The classification system demonstrated 61.1% sensitivity, 72.4% specificity, and 87.3% positive predictive value (PPV) when the DAIR cutoff was a score less than 6. For a cutoff of less than 8, sensitivity was 100%, specificity was 37.9%, and PPV was 83.3%.

CONCLUSIONS

To date, no consensus exists on a classification system predicting DAIR success. This novel scoring system, with high PPV, shows promise. Further refinement is essential for enhanced predictive accuracy.

The reimbursement system can influence the treatment choice and favor joint replacement versus other less invasive solutions in patients affected by osteoarthritis

PURPOSE

The aim of this study was to assess how physicians perceive the role of the reimbursement system and its potential influence in affecting their treatment choice in the management of patients affected by osteoarthritis (OA).

METHODS

A survey was administered to 283 members of SIAGASCOT (Italian Society of Arthroscopy, Knee, Upper Limb, Sport, Cartilage and Orthopaedic Technologies), a National scientific orthopaedic society. The survey presented multiple choice questions on the access allowed by the current Diagnosis-Related Groups (DRG) system to all necessary options to treat patients affected by OA and on the influence toward prosthetic solutions versus other less invasive options.

RESULTS

Almost 70% of the participants consider that the current DRG system does not allow access to all necessary options to best treat patients affected by OA. More than half of the participants thought that the current DRG system favors the choice of prosthetic solutions (55%) and that it can contribute to the increase in prosthetic implantation at the expense of less invasive solutions (54%). The sub-analyses based on different age groups, professional roles, and places of work allowed to evaluate the response in each specific category, confirming the findings for all investigated aspects.

CONCLUSIONS

This survey documented that the majority of physicians consider that the reimbursement system can influence the treatment choice when managing OA patients. The current DRG system was perceived as unbalanced in favor of the choice of the prosthetic solution, which could contribute to the increase in prosthetic implantation at the expense of other less invasive options for OA management.

Quantifying the Opportunity Cost of Neurosurgical Resident Education

BACKGROUND/OBJECTIVE

Education is at the core of neurosurgical residency, but little research in to the cost of neurosurgical education exists. This study aimed to quantify costs of resident education in an academic neurosurgery program using traditional teaching methods and the Surgical Autonomy Program (SAP), a structured training program.

METHODS

SAP assesses autonomy by categorizing cases into zones of proximal development (opening, exposure, key section, and closing). All first-time, 1-level to 4-level anterior cervical discectomy and fusion (ACDF) cases between March 2014 and March 2022 from 1 attending surgeon were divided into 3 groups: independent cases, cases with traditional resident teaching, and cases with SAP teaching. Surgical times for all cases were collected and compared within levels of surgery between groups.

RESULTS

The study found 2140 ACDF cases, with 1758 independent, 223 with traditional teaching, and 159 with SAP. For 1-level to 4-level ACDFs, teaching took longer than it did with independent cases, with SAP teaching adding additional time. A 1-level ACDF performed with a resident (100.1 ± 24.3 minutes) took about as long as a 3-level ACDF performed independently (97.1 ± 8.9 minutes). The average time for 2-level cases was 72.0 ± 18.2 minutes independently, 121.7 ± 33.7 minutes traditional, and 143.4 ± 34.9 minutes SAP, with significant differences among all groups.

CONCLUSIONS

Teaching takes significant time compared with operating independently. There is also a financial cost to educating residents, because operating room time is expensive. Because attending neurosurgeons lose time to perform more surgeries when teaching residents, there is a need to acknowledge surgeons who devote time to training the next generation of neurosurgeons.

Pediatric Limb Lengthening and Reconstruction Surgical Coding Survey Results

BACKGROUND

In surgical specialties like orthopaedics, documenting the surgery performed involves applying the appropriate current procedural terminology (CPT) code(s). For limb reconstruction surgeons, the wide-ranging types of surgeries and rapid evolution of the field create a variety of factors making it difficult to code the procedures. We sought to (1) assess whether appropriate limb reconstruction codes currently exist and (2) determine whether there is agreement among experienced pediatric orthopaedic surgeons when applying these codes to similar cases.

METHODS

A REDCAP survey comprised of 10 common pediatric limb reconstruction cases was sent to experienced pediatric limb reconstruction surgeons in the United States. Based on the description of each case, the surgeons were asked to code the cases as they usually would in their practice. There were no limitations regarding the number or the types of codes each surgeon could choose to apply to the case. Nine additional demographic and general coding questions were asked to gauge the responding surgeon's coding experience.

RESULTS

Survey participants used various codes for each case, ranging from only 1 code to a maximum of 9 codes to describe a single case. The average number of codes per case ranged from 1.2 to 3.6, with an average of 2.5 among all 10 cases. The total number of unique codes provided by the respondents for each case ranged from 5 to 20. Only 3 of the 10 cases had an agreement >75% for any single code, and only 2 of the 10 cases had >50% agreement on any combination of 2 codes.

CONCLUSIONS

There are dramatic variations in coding methods among pediatric orthopaedic limb reconstruction surgeons. This information highlights the need to improve the current CPT coding landscape. Possible solutions include developing new codes that better represent the work done, developing standardized guidelines with the existing codes to decrease variation, and improving CPT coding education by developing limb reconstruction coding "champions."

LEVEL OF EVIDENCE

Level V.

Does Work Relative Value Unit Measure Surgical Complexity for Risk Adjustment of Surgical Outcomes?

INTRODUCTION

The purpose of this study was to determine whether the work relative value unit (workRVU) of a patient's operation can be useful as a measure of surgical complexity for the risk adjustment of surgical outcomes.

METHODS

We retrospectively analyzed the American College of Surgeon's National Surgical Quality Improvement Program database (2005-2018). We examined the associations of workRVU of the patient's primary operation with preoperative patient characteristics and associations with postoperative complications. We performed forward selection multiple logistic regression analysis to determine the predictive importance of workRVU. We then generated prediction models using patient characteristics with and without workRVU and compared c-indexes to assess workRVU's additive predictive value.

RESULTS

7,507,991 operations were included. Patients who were underweight, functionally dependent, transferred from an acute care hospital, had higher American Society of Anesthesiologists class or who had medical comorbidities had operations with higher workRVU (all P < 0.0001). The subspecialties with the highest workRVU were neurosurgery (mean = 22.2), thoracic surgery (mean = 21.1), and vascular surgery (mean = 18.8) (P < 0.0001). For all postoperative complications, mean workRVU was higher for patients with the complication than those without (all P < 0.0001). For eight of 12 postoperative complications, workRVU entered the logistic regression models as a predictor variable in the 1st to 4th steps. Addition of workRVU as a preoperative predictive variable improved the c-index of the prediction models.

CONCLUSIONS

WorkRVU was associated with sicker patients and patients experiencing postoperative complications and was an important predictor of postoperative complications. When added to a prediction model including patient characteristics, it only marginally improved prediction. This is possibly because workRVU is associated with patient characteristics.

Epidemiology of total hip arthroplasty: demographics, comorbidities and outcomes

BACKGROUND

Primary THA (THA) is a successful procedure for end-stage hip osteoarthritis. In the setting of a failed THA, revision total hip arthroplasty (rTHA) acts as a salvage procedure. This procedure has increased risks, including sepsis, infection, prolonged surgery time, blood loss, and increased length of stay. Increasing focus on understanding of demographics, comorbidities, and inpatient outcomes can lead to better perioperative optimization and post-operative outcomes. This epidemiological registry study aimed to compare the demographics, comorbidity profiles, and outcomes of patients undergoing THA and rTHA.

METHODS

A retrospective review of discharge data reported from 2006 to the third quarter of 2015 using the National Inpatient Sample registry was performed. The study included adult patients aged 40 and older who underwent either THA or rTHA. A total of 2,838,742 THA patients and 400,974 rTHA patients were identified.

RESULTS

The primary reimbursement for both THA and rTHA was dispensed by Medicare at 53.51% and 65.36% of cases respectively. Complications arose in 27.32% of THA and 39.46% of rTHA cases. Postoperative anemia was the most common complication in groups (25.20% and 35.69%). Common comorbidities in both groups were hypertension and chronic pulmonary disease. rTHA indications included dislocation/instability (21.85%) followed by mechanical loosening (19.74%), other mechanical complications (17.38%), and infection (15.10%).

CONCLUSION

Our data demonstrated a 69.50% increase in patients receiving THA and a 28.50% increase in rTHA from the years 2006 to 2014. The data demonstrated 27.32% and 39.46% complication rate with THA and rTHA, with postoperative anemia as the most common cause. Common comorbidities were hypertension and chronic pulmonary disease. Future analyses into preoperative optimizations, such as prior consultation with medical specialists or improved primary hip protocol, should be considered to prevent/reduce postoperative complications amongst a progressive expansion in patients receiving both THA and rTHA.