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Related Experiment Video

Updated: Dec 11, 2025

The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report
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A Case Complexity Modifier Is Warranted for Primary Total Knee Arthroplasty.

Sean P Ryan1, Christine J Wu1, Johannes F Plate2

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

The Journal of Arthroplasty
|August 23, 2020
PubMed
Summary

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Complex primary total knee arthroplasty (TKA) cases are identifiable preoperatively. These cases incur higher costs and longer care times, necessitating a complexity modifier for fair reimbursement.

Area of Science:

  • Orthopedic surgery
  • Health economics
  • Healthcare policy

Background:

  • The Center for Medicare and Medicaid Services aims to reduce total knee arthroplasty (TKA) costs.
  • Current reimbursement lacks modifiers for primary TKA complexity, risking patient selection bias.
  • This study investigates perioperative differences in complex primary TKA.

Purpose of the Study:

  • To identify preoperative indicators of complex primary TKA.
  • To assess the impact of complexity on cost, care duration, and outcomes.
  • To inform future reimbursement models and prevent bias.

Main Methods:

  • Retrospective review of 1043 primary TKAs (2015-2018).
  • Analysis of demographics, radiographic angles (mPTA, lDFA), contracture, cost, and outcomes.
Keywords:
case complexitycoronal malalignmentcost of caremodifiertotal knee arthroplasty

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  • Definition of complex TKA (requiring stems or augments), with logistic regression and propensity score matching.

    • Main Results:

    • 8.3% of TKAs were complex, showing longer surgery, higher costs, and increased 90-day returns.
    • Preoperative deviations in mPTA and lDFA were significant.
    • Specific preoperative thresholds for mPTA, lDFA, contracture, and BMI identified complex cases.

    Conclusions:

    • Complex primary TKA cases can be identified preoperatively.
    • These cases are associated with increased operative time, cost, and hospital returns.
    • A complexity modifier is warranted for TKA reimbursement models to address bias.