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How Does Conversion Total Hip Arthroplasty Compare to Primary?

Scott J Douglas¹, Ethan A Remily¹, Oliver C Sax¹

¹Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital, Baltimore, MD.

The Journal of Arthroplasty

|January 10, 2021

Summary

Conversion total hip arthroplasty (THA) leads to more complications, higher readmission rates, and increased costs compared to primary THA. This highlights the need for separate reimbursement classifications for conversion THA procedures.

Keywords:

conversion conversion total hip cost infection primary total hip total hip arthroplasty

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Area of Science:

Orthopedic Surgery
Health Economics
Medical Data Analysis

Background:

Institutional data indicates conversion total hip arthroplasty (THA) has higher complication rates and costs than primary THA.
Current reimbursement systems group conversion and primary THAs under the same diagnosis-related group, despite differing outcomes.

Purpose of the Study:

To compare complication rates, 30-day readmission rates, and 90-day costs between conversion THA and matched primary THA patients.
To provide evidence for reclassifying conversion THA into a distinct diagnosis-related group.

Main Methods:

Retrospective review of the PearlDiver database (2010-2018).
Comparison of conversion THA (CPT 27132) and primary THA (CPT 27130) using matched patient data (n=8369 conversion, n=25,081 primary).
Matching criteria included age, gender, Charlson Comorbidity Index, BMI, tobacco use, and diabetes.

Main Results:

Conversion THA showed significantly higher rates of periprosthetic joint infections (7.7% vs 1.4%), dislocations (4.5% vs 2.0%), blood transfusions (2.0% vs 1.0%), mechanical complications (5.5% vs 1.0%), and revision surgeries (4.0% vs 1.5%) within 90 days.
The 30-day readmission rate was higher for conversion THA (7.3% vs 3.3%).
Median 90-day costs were significantly higher for conversion THA ($18,800 vs $13,611).

Conclusions:

Conversion THA is associated with increased complications, revisions, readmissions, and costs compared to primary THA.
The findings support the reclassification of conversion THA into a separate diagnosis-related group from primary THA to reflect its distinct risk and cost profile.