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Risk Factors for Increased Hospital Cost for Primary Total Knee Arthroplasty
Matthew Goldner1, Hemant P Reddy1, Michael Biskup2
1Montefiore Medical Center/Albert Einstein College of Medicine, Department of Orthopedic Surgery, 1250 Waters Place, Tower 2, Bronx, NY, USA 10461.
The Journal of Arthroplasty
|June 29, 2026
Summary
Higher medical comorbidity scores, including obesity (body mass index ≥ 35), diabetes, and heart failure, significantly increase the cost of primary total knee arthroplasty (TKA). Understanding these factors is crucial for managing TKA expenses.
Area of Science:
- Orthopedic Surgery
- Health Economics
- Medical Comorbidity Research
Background:
- Patients with complex medical comorbidities incur higher costs for primary total knee arthroplasty (TKA).
- Quantifying the impact of these comorbidities on TKA expenses is essential for cost management.
Purpose of the Study:
- To evaluate and quantify the influence of medical comorbidities on the overall cost of primary TKA.
- Identify specific patient factors that independently increase TKA hospitalization expenses.
Main Methods:
- Retrospective review of 3,077 primary TKA patient billing records (CPT code 27447) from January 2017 to March 2020.
- Analysis of cost data including anesthesia, operating room, surgeon fees, recovery, room and board, physical therapy, and medical supplies.
- Gamma regression analyses to identify associations between patient demographics, comorbidities (e.g., BMI, ASA score, CCI), and increased TKA costs.
Main Results:
- Median TKA cost was $32,129, with medical supplies ($14,966) and room/board ($4,976) as major cost drivers.
- Independent risk factors for increased cost included BMI ≥ 35, American Society of Anesthesiologists (ASA) scores of 3-4, diabetes, congestive heart failure (CHF), and mild liver disease.
- Higher Charlson Comorbidity Index (CCI) scores correlated with increased total costs, with median costs rising from $31,545 (CCI 0-5) to $35,099 (CCI ≥ 5).
Conclusions:
- Elevated BMI (≥ 35), ASA scores (3-4), diabetes, CHF, and mild liver disease are significant independent risk factors for higher costs in primary TKA.
- The overall cost of primary TKA escalates with increasing patient comorbidity burden, as indicated by CCI scores.
