Economic Burden of Revision Hip and Knee Arthroplasty in Medicare Enrollees

Background In 1984, we developed a private practice joint replacement registry (JRR) to prospectively follow patients undergoing THA and TKA to assess clinical and radiographic outcomes, complications, and implant survival. Little has been reported in the literature regarding management of this type of database, and it is unclear whether and how the information can be useful for addressing longer-term questions. Questions/purposes We answered the following questions: (1) What is the rate of followup for THA and TKA in our JRR? (2) What factors affect followup? (3) How successful is this JRR model in capturing data and what areas of improvement are identified? And (4) what costs are associated with maintaining this JRR? Methods We collected clinical data on all 12,047 patients having primary THA and TKA since 1984. Clinical and radiographic data were collected at routine followup intervals and entered into a prospective database. We searched this database to assess the rate of successful followup and data collection and to compare the effect of patient variables on followup. Costs related to database management were evaluated. Results Followup was poor at every time interval after surgery, with a tendency for worsening over time. Patients with a complication and those younger than 70 years tended to followup with greater frequency. There were difficulties with data capture and substantial expenses related to managing the database. Conclusions Our findings highlight the difficulties in managing a JRR. Followup is poor and data collection is often incomplete. Newer technologies that allow easier tracking of patients and facilitate data capture may streamline this process and control costs.

Section: Resultsmentioning

confidence: 99%

Lessons Learned From Managing a Prospective, Private Practice Joint Replacement Registry: A 25-year Experience

Carothers

White

Tripuraneni

et al. 2013

“…Rates of revision THAs and TKAs continue to increase [21,39] despite changes in implant design and surgical technique. Therefore, it is important to understand and define the epidemiology of failure of these procedures.…”

Section: Discussionmentioning

confidence: 99%

Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA

Bozic

Kamath

Ong

et al. 2015

399

235

Background Revision THA and TKA are growing and important clinical and economic challenges. Healthcare systems tend to combine revision joint replacement procedures into a single service line, and differences between revision THA and revision TKA remain incompletely characterized. These differences carry implications for guiding care and resource allocation. We therefore evaluated epidemiologic trends associated with revision THAs and TKAs. Questions/purposes We sought to determine differences in (1) the number of patients undergoing revision TKA and THA and respective demographic trends; (2) differences in the indications for and types of revision TKA and THA; (3) differences in patient severity of illness scoring between THA and TKA; and (4) differences in resource utilization (including cost and length of stay [LOS]) between revision THA and TKA. Methods The Nationwide Inpatient Sample (NIS) was used to evaluate 235,857 revision THAs and 301,718 revision TKAs between October 1, 2005 and December 31, 2010. Patient characteristics, procedure information, and resource utilization were compared across revision THAs and TKAs. A revision burden (ratio of number of revisions to total number of revision and primary surgeries) was calculated for hip and knee procedures. Severity of illness scoring and cost calculations were derived from the NIS. As our study was principally descriptive, statistical analyses generally were not performed; however, owing to the large sample size available to us through this NIS analysis, even small observed differences presented are likely to be highly statistically significant.One or more of the authors (SMK, KO, EL) are employees of Exponent, Inc, Menlo Park, CA, USA, and Philadelphia, PA, USA. One of the authors certifies that he (DJB), or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of USD 100,001-USD 1,000,000, from DePuy Orthopaedics, Inc (Warsaw, IN, USA). One of the authors (TPV) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of USD 10,001-USD 100,000 from DePuy Orthopaedics, Inc (Warsaw, IN, USA). One of the authors (HER) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of USD 100,001-USD 1,000,000, from Zimmer, Inc (Warsaw, IN, USA Clin Orthop Relat Res (2015) 473:2131-2138 DOI 10.1007/s11999-014-4078-8 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons®Results Revision TKAs increased by 39% (revision burden, 9.1%-9.6%) and THAs increased by 23% (revision burden, 15.4%-14.6%). Revision THAs were performed more often in older patients compared with revision TKAs. Periprosthetic joint infection (25%) and mechanical loosening (19%) were the most common reasons for revision TKA compared with dislocation (22%) and mechanical loosening (20%) for revision THA. Full (all-component) revision was more common i...

“…Revision TJA is more costly and surgically demanding than primary TJA, which places tremendous economic burden on the healthcare system [3,4,16,22] and provides challenges during patient management and care [6,8].…”

Section: Discussionmentioning

confidence: 99%

“…The complexity of revision TJA also is reflected by the higher hospital cost, longer length of stay, and longer operative time compared with primary procedures [3,4]. With revision procedures accounting for approximately 19% and 8% of Medicare reimbursements for all THAs and TKAs [22] in the United States, respectively, revision procedures place a tremendous economic burden on the Medicare system. Medicare reimbursements for revision TJA have been projected to exceed $8.5 billion by 2015 [16].…”

Section: Introductionmentioning

confidence: 99%

Risk of Subsequent Revision after Primary and Revision Total Joint Arthroplasty

Ong

Lau

Suggs

et al. 2010

250

155

Background Revision is technically more demanding than primary total joint arthroplasty (TJA) and requires more extensive use of resources. Understanding the relative risk of rerevision and risk factors can help identify patients at high risk who may require closer postsurgical care. Objectives/purposes We therefore evaluated the risk of subsequent revision after primary and revision TJA in the elderly (65 years or older) patient population and identified corresponding patient risk factors. Patients and Methods Using the 5% Medicare claims data set (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006), we identified a total of 35,746 patients undergoing primary THA and 72,913 undergoing primary TKA; of these, 1205 who had THAs and 1599 who had TKAs underwent initial revision surgery. The rerevision rate after primary and revision TJAs was analyzed by the Kaplan-Meier method. The relative risk of revision surgery for primary and revision TJAs was compared using hazard ratio analysis. ResultsThe 5-year survival probabilities were 95.9%, 97.2%, 81.0%, and 87.4% for primary THA and TKA and revision THA and TKA, respectively. Patients with revision arthroplasty were five to six times more likely to undergo rerevision (adjusted relative risk, 4.89 for THA; 5.71 for TKA) compared with patients with primary arthroplasty. Age and comorbidities were associated with initial revision after primary THA and TKA. Conclusions Patients should undergo stringent preoperative screening for preexisting health conditions and careful patient management and followup postoperatively so as to minimize the risk of an initial revision, which otherwise could lead to a significantly greater likelihood of subsequent rerevisions.