FINANCIAL IMPACT OF IMPLANT COST IN THE MANAGEMENT OF PERIPROSTHETIC FEMORAL FRACTURES

Abstract

The aim of this study was to evaluate the cost of implants used in a large series of peri-prosthetic femoral fractures and assess its financial impact in the era of Payment by Results

We evaluated the clinical demographic and economical data associated with 202 patients with peri-prosthetic fractures of the proximal femur in two orthopaedic centers of excellence. All fractures were classified preoperatively according to the Vancouver classification. The patients were followed up until radiographic confirmation of fracture union and post-operative outcome was recorded with reference to the patients’ mobility and any complications.

The mean age of the patients operated was 81.2 years (range 33–100 years). 55% of the patients in our series were graded type B3 and 25% type B2. 80% of all fractures underwent revision. 71 percent of the fractures united within 8.4 months. 112 patients had impaction femoral grafting. Our implant cost alone for revision varied from 1900 pounds to as high as 3500 pounds without taking in to account the cost of cement and allograft (femoral heads and struts).

Hospital resource utilization for peri-prosthetic fractures is quite high compared to the reimbursement received. This is due to hospital stay and rehabilitation needs, theatre utilization, implant cost and higher readmission rates. There are neither reference costs available nor any special tariffs for these complex fractures. The reimbursement for internal fixation of these fractures could range from £2336 to £4230 and for emergency revision hip replacement is £5928. More than 50% of the reimbursement money would just be necessary to meet the implant costs. For uncemented revisions this equation is even worse. Current HRG codes for the treatment of peri-prosthetic fractures are unrealistic and new treatment algorithms and special tariffs have to be introduced to help manage these fractures.