Surgeon work input and risk in primary versus revision total joint arthroplasty

One hundred twenty stratified nonselected cases of primary and revision total joint arthroplasties performed between 1990 and 1992 in which complete financial and clinical data were available were reviewed. All cases were performed at a single university hospital. Compared with primary total joint arthroplasty, revision surgery involved significantly more operative time, greater blood loss, increased length of stay, and a much higher complication rate. The actual physician reimbursement was not significantly more than for primary procedures. Physician reimbursement constituted 18% of the total fees collected compared with 24% for the actual prosthesis cost. Surgeons performing revision surgery devote significantly more time and are at a higher liability than when performing primary total joint arthroplasty.