Demand for total hip (THA) and knee arthroplasties (TKA) is expected to rise sharply by 2030. Increasing demand in conjunction with financial pressure requires the use of cost-effective total joint arthroplasty (TJA) strategies. This study examined the effects that day of week and surgery location [academic (AH) versus orthopaedic-specific (OsH) hospital] have on length of stay (LOS) and cost for primary TJA patients in one multihospital university-based medical center. An Institutional Review Board-approved database of adult patients undergoing primary THA or TKA from June 2013 to December 2014 was constructed. Surgery location, day of procedure, age, American Society of Anesthesiologists (ASA) classification, LOS, and cost were recorded for each patient. Data were compared for significant differences using analysis of variance, -Test or rank sum and for strength of correlations using Pearson's or Spearman's tests. A total of 1,291 patients met inclusion criteria. OsH showed significantly lower cost and shorter LOS than AH. Wednesday surgeries had significantly higher cost and longer LOS than all other days. Friday surgeries had significantly lower cost and shorter LOS than other days. ASA 3 and 4 were associated with the highest cost and longest LOS. LOS had a moderately strong direct correlation to cost. ASA did not have a strong correlation with LOS or cost. Data separated for THA and TKA showed similar results. At our institution, OsH provides more consistent and lower LOS and cost across all ASA classes. Wednesday and Thursday surgeries have increased LOS and cost than other days, which may be due to weekend discharge difficulties (average LOS is 3.0 days).

Gross trunnion failure (GTF) leading to dissociation at the femoral head-trunnion interface is an uncommon complication after total hip arthroplasty (THA). The incidence of this complication is currently unknown due to the limited number of reported cases but it is significantly more common in the context of a recalled femoral head. This report details the case of a gross trunnion failure and secondary polyethylene failure of a non-recalled metal-on-polyethylene primary THA from a taper type previously reported to be associated with an increased prevalence of mechanically assisted crevice corrosion (MACC). This case describes a 77-year-old man who was 10 years status post right THA presenting with acute-onset right hip pain after trying to rise from a seated position. Radiographs showed that the right femoral head was dissociated from the femoral component. At the time of surgical revision, there was extensive dark metallic debris in the hip joint. A revision THA was performed using a modular revision system. Clinicians must be aware that MACC can eventually lead to GTF, which can result in dissociation at the femoral head-trunnion interface in metal-on-polyethylene primary THA. Further research is needed to determine patient and implant factors that make patients susceptible to MACC/GTF so that adequate screening and patient counseling can be performed.