Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis

Abstract

Introduction Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA. Methods Fifty-one consecutive conversion THA patients (Current Procedure Terminology code 27132) and 105 matched primary THA patients (Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis. Results Conversion and primary THAs were determined to be significantly different (P < .05) and greater in the following costs: hospital operating direct cost (29.2% greater), hospital operating total cost (28.8% greater), direct hospital cost (24.7% greater), and total hospital cost (26.4% greater). Conclusions Based on greater hospital operating direct cost, hospital operating total cost, direct hospital cost, and total hospital cost, conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA.

Not all primary total hip arthroplasties are equal—so is there a difference in reimbursement?

“…It, therefore, follows that physicians should receive a higher rate of compensation for more complex procedures. There is evidence that conversion THA is a relatively frequent procedure that has longer operative times, more intraoperative blood loss, longer lengths of hospital stay, and higher costs than primary THA (24)(25)(26)(27). Surgeons should therefore receive a higher rate of compensation for conversion THA.…”

Conversion of Hemiarthroplasty to THA Carries an Increased Risk of Reoperation Compared With Primary and Revision THA

“…These studies did not specifically evaluate conversion after just hemiarthroplasty [3,13,14]. Further, few studies have evaluated the costs of conversion THA after hemiarthroplasty and compared these costs directly to primary and revision THA [5]. Thus, it would be helpful to do a formal cost analysis between matched conversion, primary, and first-time revision THAs.…”

Total hip arthroplasty for the management of hip fracture: A review of the literature

“…48 When considering HA or ORIF, it should be noted that THA conversion surgeries are much more costly than primary THA. 49 Selecting the appropriate initial surgical intervention and avoiding revision surgery is imperative in controlling cost.…”