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Cost Analysis of Conversion Total Knee Arthroplasty: A Multi-Institutional Database Study.

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  • 1Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois.

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Conversion total knee arthroplasty (convTKA) is more complex and time-consuming than primary TKA, yet yields lower RVU per minute compensation. This study highlights disparities in physician reimbursement for convTKA, advocating for code revaluation to reflect actual work effort.

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Area of Science:

  • Orthopedic Surgery
  • Health Economics
  • Surgical Outcomes

Background:

  • Conversion total knee arthroplasty (convTKA), performed after prior knee surgery, presents increased complexity, resource use, and operative time compared to primary TKA.
  • Current U.S. coding guidelines and relative value units (RVUs) may not adequately reflect the higher surgical demands of convTKA.

Purpose of the Study:

  • To compare RVUs and calculate RVU per minute for primary TKA versus convTKA.
  • To assess if current coding accurately reflects the work effort and resource utilization for convTKA.

Main Methods:

  • Analysis of the 2005-2020 American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database.
  • Propensity score matching (1:1) to create comparable cohorts of primary TKA and convTKA (n=1,600 each).
  • Calculation of RVU per minute using 2023 Medicare Physician Fee Schedule conversion factors; comparison of complication rates via multivariate logistic regression.

Main Results:

  • ConvTKA had a longer mean operative time (124.3 min) than TKA (97.8 min), resulting in a lower RVU per minute ($6.39 vs $8.11).
  • ConvTKA demonstrated significantly higher rates of overall complications (10.9% vs 6.5%), blood transfusion (6.6% vs 3.7%), reoperation (2.3% vs 0.94%), and readmission (3.7% vs 1.8%).

Conclusions:

  • Current billing guidelines result in lower compensation for convTKA despite its greater complexity and resource demands.
  • The disparity in RVU per minute may disincentivize surgeons from performing convTKA.
  • Revaluation of CPT codes for convTKA is recommended to accurately reflect the procedural time, effort, and associated risks.