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Differences in Post-Operative Outcome Between Conversion and Primary Total Hip Arthroplasty.

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Conversion total hip arthroplasty (THA) has higher complication rates and longer hospital stays than primary THA. These outcomes suggest conversion THA requires different management strategies, especially within bundled payment models.

Keywords:
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Area of Science:

  • Orthopedic Surgery
  • Health Services Research
  • Value-Based Healthcare

Background:

  • Increasing US hip fracture rates drive demand for conversion total hip arthroplasty (THA).
  • Conversion THA manages various hip conditions, necessitating outcome analysis for reimbursement.
  • Value-based reimbursement and bundled payments require understanding conversion THA outcomes.

Purpose of the Study:

  • To compare outcomes between primary total hip arthroplasty (THA) and conversion THA.
  • To analyze the impact of procedure type on adverse outcomes in hip arthroplasty.
  • To inform value-based reimbursement for conversion THA procedures.

Main Methods:

  • Utilized National Surgical Quality Improvement Project data (2005-2014).
  • Propensity-score matched primary THA and conversion THA cohorts.
  • Analyzed Center for Medicare and Medicaid Services (CMS) complications, discharge disposition, length of stay, mortality, and readmission.

Main Results:

  • Conversion THA showed higher rates of CMS complications (7.5% vs 4.5%) and non-home bound discharge (19.6% vs 14.7%).
  • Conversion THA patients experienced longer hospital stays compared to primary THA.
  • No significant differences in mortality or readmission rates were observed between groups.

Conclusions:

  • Conversion THA presents distinct risks compared to elective primary THA.
  • Elevated complications, longer stays, and discharge needs warrant modified treatment protocols.
  • Consideration for modified management within bundled payment models, like Comprehensive Care for Joint Replacement, is recommended.