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Conversion Total Knee Arthroplasty: A Distinct Surgical Procedure With Increased Resource Utilization.

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  • 1Department of Orthopaedic Surgery, Duke University, Durham, NC.

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Conversion total knee arthroplasty (TKA) requires more operative time, causes more blood loss, and leads to higher complication rates than primary TKA. Current coding and reimbursement may disincentivize surgeons from performing these complex procedures.

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conversion total knee arthroplastyhigh tibial osteotomyopen reduction internal fixationperiarticular hardwarepost-traumatic arthritis

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Area of Science:

  • Orthopedic Surgery
  • Arthroplasty Research
  • Surgical Outcomes Analysis

Background:

  • Current Procedural Terminology coding does not differentiate between primary total knee arthroplasty (TKA) and conversion TKA.
  • Conversion TKA involves removing periarticular hardware, adding complexity.
  • The study hypothesizes increased operative time, blood loss, and complications for conversion TKA.

Purpose of the Study:

  • To compare operative time, blood loss, and postoperative complications between conversion TKA and primary TKA.
  • To evaluate the impact of hardware removal timing on outcomes.
  • To inform coding and reimbursement policies for conversion TKA.

Main Methods:

  • Matched cohort study comparing 109 conversion TKA patients with 109 primary TKA patients.
  • Data collected from an institutional database (2005-2017).
  • Comparison of intraoperative data and 90-day postoperative complications.

Main Results:

  • Conversion TKA showed significantly increased tourniquet time, operative time, blood loss, and 90-day readmissions.
  • Higher rates of wound complications, periprosthetic joint infections, and irrigation/debridement procedures were observed in conversion TKA.
  • Timing of hardware removal (prior to or during TKA) did not significantly impact outcomes.

Conclusions:

  • Conversion TKA is associated with greater operative resource utilization and poorer outcomes compared to primary TKA.
  • Lack of appropriate billing codes and reimbursement may discourage surgeons from performing conversion TKA.
  • Revised coding and reimbursement are needed to reflect the complexity and resource demands of conversion TKA.