Revision Total Joint Arthroplasty: Does Medicare Reimbursement Justify Time Spent?

Abstract

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.

MAVRIC based T2 mapping assessment of infrapatellar fat pad scarring in patients with total knee arthroplasty

“…TKA incidence is expected to increase considerably in the future, with estimates of a 401% increase in projected total annual US use for primary TKA by 2040 2 . While postoperative patient satisfaction is generally high for TKA, studies have reported that 3%−5% of TKAs fail each year 3,4 and 7‐20% of patients report function loss and pain 5 . Further research is needed to elucidate anatomic and biological factors that may contribute to or help predict TKA failure.…”

Some clinical factors of aseptic instability of the knee joint endoprosthesis

“…Найбільш частою причиною ревізійного протезування є нестабільність його компонентів, яка поділяється та інфекційну та асептичну, що сумарно становить близько 60 % від усіх ускладнень. Актуальною є проблема ревізійного ендопротезування колінного суглоба перш за все з економічної точки зору: середня вартість імплантатів збільшується на 18-24 % [5], час, який витрачається хірургом на виконання ревізійного втручання, збільшується порівняно з первинним ендопротезуванням [6], загальна вартість лікування пацієнта для клі-УДК 617.089. 28…”