A dedicated revision total knee service: a surgeon’s perspective.

Area of Science:

• Orthopedic Surgery
• Arthroplasty Research
• Health Economics

Background:

• Revision total knee arthroplasty (rTKA) represents 5-10% of total knee arthroplasties (TKAs), involving complex procedures.
• The economic value and surgeon productivity associated with dedicated rTKA services require further investigation.

Purpose of the Study:

• To compare surgeon productivity across different operational models for primary and revision total knee arthroplasty.
• To evaluate the financial implications of establishing a specialized rTKA service.

Main Methods:

• Analysis of 4570 primary and revision TKAs performed between January 2016 and June 2018.
• Comparison of surgical time and work relative value units (RVUs) across primary TKA, liner exchange, and full rTKA procedures.
• Modeling surgeon productivity using single and dual operating theatre (OT) scenarios for primary TKA versus rTKA.

Main Results:

• Revision TKAs took significantly longer (141.7 minutes) than primary TKAs (100.6 minutes).
• Primary TKA generated 7.1% more RVU/min than rTKA.
• Dedicated rTKA services showed a productivity disadvantage compared to primary TKA, especially in dual-OT models.

Conclusions:

• Current RVU-based compensation models may undervalue surgeon productivity in dedicated rTKA services.
• Incentive structures and productivity metrics need revision to encourage the development of specialized rTKA services.
• Optimizing rTKA services can enhance care quality, but requires adjusted surgeon productivity assessments.