Analyzing the Burden of Revision Total Knee Arthroplasty in the United States between 2009 and 2016

Abstract

As the number of total knee arthroplasties (TKAs) increases, it is reasonable to expect the number of revision TKAs (rTKAs) to rise in parallel. The patient-related and societal burdens of rTKA are poorly understood. Therefore, the purpose of this study was to determine temporal changes in: (1) the incidence of rTKA; (2) patient and hospital characteristics; (3) complications, hospital lengths of stay (LOSs), and discharge dispositions; and (4) costs, charges, and payer types. All patients who underwent rTKA between 2009 and 2016 were identified from the National Inpatient Sample database using International Classification of Diseases, Ninth Revision and Tenth Revision codes and were studied. Univariate analyses were performed to compare the incidence of rTKA, patient and hospital characteristics, LOS and discharge dispositions, as well as costs, charges, and payer types. A multivariate logistic regression model was built to compare the odds of complications in 2009 and 2016. Over our study period, there was a 4.3% decrease in the incidence of rTKA. The mean age of patients who underwent rTKA was 65 years and a majority were female (58%). Mean hospital LOS decreased from 4.1 days in 2009 to 3.3 days in 2016 (p < 0.001). The rate of several complications decreased significantly over our study period including myocardial infarction, cardiac arrest, transfusion, pneumonia, urinary tract infection, and mortality. A significantly lower percentage of rTKA patients were discharged to a skilled nursing facility in 2016 (26.5%) compared with 2009 (31.6%; p < 0.001). There was an 18.7% increase in the mean costs, and a 43.3% increase in the mean charges (p < 0.001). Over the study period, there was a decrease in the incidence of rTKAs. Despite potential improvements in primary TKA, the burden associated with rTKA remains large. This report can be used to help educate medical providers about outcomes that may result from a primary and/or revised TKA.

Revision total knee arthroplasty results in financial deficits within the Swiss healthcare system

“…However, the increasing number of PTKA procedures is associated with an increased revision burden [13, 18, 24], and costs for RTKA are significantly higher than those for PTKA, especially for septic two‐stage RTKA [7, 12, 19, 23]. In a recent study, Livshetz et al analyzed the burden of RTKA in the United States between 2009 and 2016, using the National Inpatient Sample (NIS) database, and showed a significant increase of the costs for RTKA during the inclusion period [14]. Despite the continuously increasing healthcare costs, reimbursement for RTKA has not shown an adequate increase over the last two decades [10].…”

The Epidemiology of Revision Total Knee Arthroplasty

“…It was previously expected that the number of rTKAs would grow in parallel with the increase in TKAs. 1 2 4 7 20 21 In a NIS database study on patients who underwent a rTKA between 2009 and 2016, Livshetz et al 21 examined the economic burden, incidence, complications, hospital lengths of stay, costs, charges, and payer types for rTKA in the United States health care system. Of the 453,770 rTKAs performed, the authors determined that there was a 4.3% decrease in the incidence of rTKA.…”