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Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
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Published on: February 27, 2018

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Conversion vs Primary Total Hip Arthroplasty: Increased Cost of Care and Perioperative Complications

Sean P Ryan1, Marcus DiLallo1, David E Attarian1

  • 1Department of Orthopaedic Surgery, Duke University Hospital, Durham, North Carolina.

The Journal of Arthroplasty
|April 17, 2018
PubMed

Insights

Conversion total hip arthroplasty (THA) is significantly more expensive and complex than primary THA, leading to higher costs and complication rates. Reclassifying conversion THA reimbursement is recommended to ensure equitable patient access to care.

Area of Science:

  • Orthopedic Surgery
  • Health Economics

Background:

  • Rising incidence of hip fractures and hip preservation surgeries increases conversion total hip arthroplasty (THA) procedures.
  • Prior research indicates higher complication rates for conversion THA compared to primary THA.
  • Limited data exists on cost differences between primary and conversion THA.

Purpose of the Study:

  • To compare the perioperative costs and outcomes of conversion THA versus primary THA.
  • To provide evidence for potential reclassification of conversion THA reimbursement by the Center for Medicare and Medicaid Services.

Main Methods:

  • A retrospective analysis of 163 conversion THAs and 163 matched primary THAs from an institutional database (2012-2015).
  • Evaluation of intraoperative complications, estimated blood loss, operative time, postoperative complications, and perioperative costs.
  • Matched cohort comparison between conversion THA and primary THA groups.

Main Results:

  • Conversion THA incurred significantly higher costs across multiple categories, including labor, supplies, and ancillary services, totaling approximately 19% more than primary THA.
  • Conversion THA was associated with significantly longer operative times, greater blood loss, extended hospital stays, and increased intraoperative and postoperative complications.
  • Statistical significance (P < .05) was observed for all compared cost and complication metrics.

Conclusions:

  • Conversion THA presents substantially greater financial and clinical burdens compared to primary THA.
  • The current bundled reimbursement for primary and conversion THA may not adequately reflect the increased resources and risks associated with conversion procedures.
  • Reclassification of the Medicare Severity-Diagnosis Related Group for conversion THA or implementation of modifiers is advised to address cost disparities and prevent access barriers.
Abstract

Keywords:
complicationsconversioncostprimaryresourcestotal hip arthroplasty

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