Related Experiment Video
Updated: Feb 19, 2026
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Readmission, Reoperation, and Complications: Total Hip vs Total Knee Arthroplasty
Jaiben George1, Morad Chughtai1, Anton Khlopas1
1Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio.
Insights
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) have different 30-day readmission and reoperation rates. These differences suggest that a single bundled payment may not be appropriate for both procedures.
Area of Science:
- Orthopedic surgery
- Health economics
- Quality improvement
Background:
- Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are often grouped under the same Diagnosis-Related Group (DRG).
- Bundled payments hold providers accountable for the total episode of care costs, including readmissions and complications.
- It remains unclear if readmission rates and short-term complications differ between primary THA and TKA.
Purpose of the Study:
- To compare 30-day readmission, reoperation, and complication rates between primary total hip arthroplasty and total knee arthroplasty.
- To inform the appropriateness of using a single bundled payment for both procedures.
Main Methods:
- A retrospective analysis of the National Surgical Quality Improvement Project database (2011-2015).
- Included 248,150 primary THA/TKA procedures, excluding hip fractures and bilateral procedures.
- Multivariate regression models were used to compare outcomes, adjusting for baseline characteristics.
Main Results:
- Length of stay and discharge disposition were similar between THA and TKA.
- Total hip arthroplasty (THA) demonstrated significantly higher 30-day readmission (P < .001) and reoperation (P < .001) rates compared to TKA.
- Among 18 complications, 7 were higher in THA, 3 in TKA, and 8 were similar.
Conclusions:
- Total hip arthroplasty patients experienced higher 30-day readmission and reoperation rates.
- The differing rates of readmissions and reoperations suggest that a uniform bundled payment for THA and TKA may be inappropriate.
- Further research is needed to fully elucidate the differences in episode costs between THA and TKA.
Background:
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are currently grouped under the same Diagnosis-Related Group (DRG). With the introduction of bundled payments, providers are accountable for all the costs incurred during the episode of care, including the costs of readmissions and management of complications. However, it is unclear whether readmission rates and short-term complications are similar in primary THA and TKA.
Methods:
The National Surgical Quality Improvement Project database was queried from 2011 to 2015 to identify 248,150 primary THA/TKA procedures using Current Procedural Terminology codes. After excluding 1602 hip fractures and 5062 bilateral procedures, 94,326 THAs and 147,160 TKAs were included in the study. Length of stay, discharge disposition, and 30-day readmission, reoperation and complication rates were compared between THA and TKA using multivariate regression models.
Results:
After adjusting for baseline characteristics, length of stay (P = .055) and discharge disposition (P = .304) were similar between THA and TKA. But the 30-day rates of readmission (P < .001) and reoperation (P < .001) were higher in THA. Of the 18 complications evaluated in the study, 7 were higher in THA, 3 were higher in TKA, and 8 were similar between THA and TKA.
Conclusion:
THA patients had higher 30-day rates of readmission and reoperation. As both readmissions and reoperations can result in higher episode costs, a common target price for both THA and TKA may be inappropriate. Further studies are required to fully understand the extent of differences in the episode costs of THA and TKA.
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Kidney Transplant II: Surgical Procedure