Abstract
Backgroud: Revision total knee arthroplasty (TKA) consumes considerably more resources than primary TKA. Management of infected arthroplasty has been shown to require even more resources in terms of inpatient stay, microbiological investigation, multiple stage procedures and more complex implants than treatment of aseptic failures. We investigated the trends in cost of revision TKA over a 10 year period.
Patients and Methods: Between 1997 and 2006, 189 patients underwent revision total knee arthroplasty in our institution. The perioperative data was available for 181 of these (95.77%). Data collected included age, gender, diagnosis, number of revisions length of stay, operative time, blood loss, number of units of blood transfused and ASA grade. Financial data included cost of implants and instrumentation, cost and number of bed-days, investigations and treatment. In the case of 2 stage revisions involving 2 admissions, the cumulative data was compiled as a single episode.
Results: The study group comprised 123 females (65.07%) and 66 males (34.93%). The mean age for both groups was 68.97 (range of 20 to 91years), with a 6.7% increase in mean age over the ten year period (66.75 to 71.19). The mean ASA score dropped from 2.67 in 1997 to 2.23 in 2006. The number of revision surgeries per year increased over the study period from 8 to 36. The number of TKA revisions for infection over the 10 years was 18(9.5%).
The mean length of stay for revision due to aseptic loosening in 1997 was 14.3 days. The average length of stay for revision for infected arthroplasty was 35 days. In 2006, the length of stay increased to 65 days for infected arthroplasty and 15.03 days for aseptic cases.
The mean total cost of aseptic revision per patient was 12,409.92 (range 8,822.58–13,559.65) euro in 1997 with revisions for infection costing 20,888.66 euro, a difference of 68.32%.
The industry cost of implants increased by 32–35% (€3119–€4371 and €4216–€5800) between 1999 and 2006 depending on implant selection. There was a 20– 42% increase in generic hospital costs (admission, investigation and treatment related costs) in the same period.
Conclusion: With increasing life expectancy and increased indication for primary arthroplasty more patients are coming to revision surgery. The cost of Revision TKR has increased steadily over the last 10 years. Revision TKR for infection remains significantly more expensive than revision for aseptic loosening or other causes and provides a significant financial burden on orthopaedic services. Infected arthroplasty incurs significantly greater cost and every precaution should be taken to avoid infection in total knee arthroplasty.
Correspondence should be addressed to: EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland. Email: office@efort.org
