Revision total joint arthroplasty: does medicare reimbursement justify time spent?

In 1991, five different total joint replacement surgeons performed 337 primary total knee replacements and 250 primary total hip replacements. They revised 25 total knee replacements and 73 total hip replacements. The average length of stay was 6.6 days for the primary total knee arthroplasty and 7.5 days for knee revisions. For total hip replacement, average stay was 5.9 days for primary surgery and 6 days for revisions. The operative time required for each of the five surgeons to complete a total knee replacement increased 55%, 3%, 38%, 72% and 38%; whereas for the total hip replacement, time increased 87%, 77%, 84% and 58%. Overall, there was a 41% increase in operating time for revision total knee replacements and a 77% increase for revision total hip replacement. Allowable charges by Medicare in 1993 for a primary knee and hip replacement were $1,298 and $1,363, respectively. Revision total knee replacement increased 24.3% ($1,613) and revision total hip replacement increased 30.8% ($1,782) in the state of Indiana. These figures do not encourage those surgeons who are capable of doing total joint replacements to revise other surgeons' problems.