Economic Burden of Revision Hip and Knee Arthroplasty in Medicare Enrollees

Exponent Inc, Philadelphia, PA, USA.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 06/2006; 446(446):22-8. DOI: 10.1097/01.blo.0000214439.95268.59
Source: PubMed


The economic burden to Medicare due to revision arthroplasty procedures has not yet been studied systematically. The economic burden of revisions was calculated as annual reimbursements for revision arthroplasties relative to the sum total reimbursements of primary and revision arthroplasties. We evaluated this revision burden for total hip and knee arthroplasties through investigation of trends in charges and reimbursements in the Medicare population (Parts A and B claims from 1997-2003), while taking into account age and gender effects. Mean annual economic revision burdens were 18.8% (range, 17.4-20.2%) and 8.2% (range, 7.5-9.2%) for total hip arthroplasties and total knee arthroplasties, respectively. Procedural charges increased while reimbursements decreased over the study period, with higher charges observed for revisions than primary arthroplasties. Reimbursements per procedure were 62% to 68% less than associated charges for primary and revision total hip and knee arthroplasties. The effect of age and gender on reimbursements varied by procedure type. Unless some limiting mechanism is implemented to reduce the incidence of revision surgeries, the diverging trends in reimbursements and charges for total hip and knee arthroplasties indicate that the economic impact to the Medicare population and healthcare system will continue to increase. Level of Evidence: Prognostic study, level II-1 (retrospective study). See Guidelines for Authors for a complete description of levels of evidence.

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    • "Total hip arthroplasty (THA) is the 'operation of the century' according to Learmonth et al. [1] in 2007. Despite improvements in the techniques, approaches, and prosthetic materials and designs, THA survival remains limited and the frequency of revision THA (reTHA) is increasing steadily [2]. In national registries, the main reasons for the first reTHA are as follows, in order of decreasing frequency: aseptic loosening, instability, infection, peri-prosthetic fracture (PPF), and pain [3] [4] [5] [6] [7] [8]. "
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    ABSTRACT: Revision total hip arthroplasty (reTHA) for peri-prosthetic fracture (PPF) is increasingly performed but still ranks fourth among reasons for reTHA in registries. In France, no specific registry is available and the frequency of PPF among reasons for THA revision is therefore unknown. Here, our objectives were to determine the relative frequency of PPF as a reason for reTHA, to identify patient-related and primary-THA-related factors associated with reTHA for PPF, to describe reTHA modalities for PPF, and to determine the morbidity and mortality associated with reTHA for PPF.
    Full-text · Article · Oct 2014 · Orthopaedics & Traumatology Surgery & Research
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    • "La prothèse totale de hanche (PTH) a été qualifiée par Learmonth et al. [1] « d'intervention du siècle ». Malgré l'amélioration des techniques , des voies d'abord, des matériaux et du dessin des implants, la durée de vie des PTH reste limitée avec un taux de reprises de PTH (rePTH) qui augmente régulièrement [2]. Les registres nationaux rapportent que les causes de rePTH (à l'exclusion des reprises itératives ) sont par ordre de fréquence décroissante : le descellement aseptique, l'instabilité, l'infection, la fracture péri-prothétique et la douleur [3] [4] [5] [6] [7] [8]. "
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    ABSTRACT: La reprise des prothèses totales de hanche (rePTH) pour fracture péri-prothétique (FPP) est de plus en plus fréquente, mais elle demeure la quatrième cause de révision dans les registres et sa place par rapport aux autres indications de révision n’est pas connue en France du fait de l’absence de registre. Les objectifs de ce travail étaient de préciser : (1) la fréquence relative de cette cause de reprise ; (2) le terrain de survenue et le type de PTH primaire ; (3) les modalités de révision ; (4) la morbi-mortalité de ces interventions.
    Full-text · Article · Oct 2014 · Revue de Chirurgie Orthopédique et Traumatologique
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    • "In the US, over 50,000 revision THAs are performed every year at a direct cost exceeding $1 billion [4]. Due in part to continued growth in the utilization of primary THA, the number of revisions may increase substantially in the coming decades [5]. "
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    ABSTRACT: Background Numerous papers have been published examining risk factors for revision of primary total hip arthroplasty (THA), but there have been no comprehensive systematic literature reviews that summarize the most recent findings across a broad range of potential predictors. Methods We performed a PubMed search for papers published between January, 2000 and November, 2010 that provided data on risk factors for revision of primary THA. We collected data on revision for any reason, as well as on revision for aseptic loosening, infection, or dislocation. For each risk factor that was examined in at least three papers, we summarize the number and direction of statistically significant associations reported. Results Eighty-six papers were included in our review. Factors found to be associated with revision included younger age, greater comorbidity, a diagnosis of avascular necrosis (AVN) as compared to osteoarthritis (OA), low surgeon volume, and larger femoral head size. Male sex was associated with revision due to aseptic loosening and infection. Longer operating time was associated with revision due to infection. Smaller femoral head size was associated with revision due to dislocation. Conclusions This systematic review of literature published between 2000 and 2010 identified a range of demographic, clinical, surgical, implant, and provider variables associated with the risk of revision following primary THA. These findings can inform discussions between surgeons and patients relating to the risks and benefits of undergoing total hip arthroplasty.
    Full-text · Article · Dec 2012 · BMC Musculoskeletal Disorders
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