Aims. Revision total knee arthroplasty (rTKA) accounts for approximately 5% to 10% of all TKAs. Although the complexity of these procedures is well recognized, few investigators have evaluated the cost and value-added with the implementation of a dedicated revision arthroplasty service. The aim of the present study is to compare and contrast surgeon productivity in several differing models of activity. Materials and Methods. All patients that underwent primary or revision TKA from January 2016 to June 2018 were included as the primary source of data. All rTKA patients were categorized by the number of components revised (e.g. liner exchange, two or more components). Three models were used to assess the potential surgical productivity of a dedicated rTKA service : 1) work relative value unit (RVU) versus mean surgical time; 2) primary TKA with a single operating theatre (OT) versus rTKA with a single OT; and 3) primary TKA with two OTs versus rTKA with a single OT. Results. In total, 4570 procedures were performed: 4128 primary TKAs, 51 TKA liner exchanges, and 391 full rTKAs. Surgical time was significantly different between the primary TKA, liner exchange, and rTKA cohorts (100.6, 97.1, and 141.7 minutes, respectively; p < 0.001). Primary TKA yielded a mean of 7.1% more RVU/min per procedure than rTKA. Our one-OT model demonstrated that primary TKA (n = 4) had a 1.9% RVU/day advantage over rTKA (n = 3). If two OTs are used for primary TKA (n = 6), the outcome strongly favours primary TKA by an added 34.6% RVUs/day. Conclusion. Our results suggest that a dedicated rTKA service would lead to lower surgeon remuneration based on the current RVU paradigm. Revision arthroplasty specialists may need additional or alternative incentives to promote the development of a dedicated revision service. Through such an approach, healthcare organizations could enhance the quality of care provided, but surgeon productivity measures would need to be adjusted to reflect the burden of these cases. Cite this article: Bone Joint J 2019;101-B:675–681

Introduction. Studies are being done comparing 1-stage vs. 2-stage protocols for PJI. 1-stage protocols take an extended period of time requiring 2 separate preps and sets of instruments in order to ensure optimal sterility. While intraoperative service time is one part of the reimbursement algorithm, reimbursement has lagged behind for single stage treatment. If 1-stage results are acceptable, but not reimbursed appropriately, surgeons may be discouraged from managing PJI in a 1-stage fashion. We ask, “What is the reimbursement and intraoperative service time for 1-stage procedures compared to primary surgery?”. Methods. Relative Value Unit's (RVU's), reimbursement and operative time for 50 PJI procedures were reviewed and compared to 250 primary (1°) THA and 250 primary (1°) TKA by four surgeons. Coding was done per AAOS guidelines. Results. Average work RVU's for 1-stage knees were 19.79 RVU's/hr. vs 23.47 for 1° TKA. Average reimbursement for a 1-stage knee was $2,597.08, with an average intraoperative service time of 259 minutes ($601.60/hr.). Average reimbursement for a 1° TKA was $2,435.00, with an average service time of 100 minutes ($1,461/ hr.). Average work RVU's for a 1-stage hip were 19.57/hr. vs 25.59 for a 1° THA. Average reimbursement for a 1-stage hip was $2,826.17, with an average intraoperative service time of 311 minutes ($545.24/ hr.). The average reimbursement for a 1° total hip was $2,754.71 with an average service time of 104 minutes ($1,589.26/ hr.). Conclusion. While RVUs/hr are similar between primaries and 1-stage procedures, 1-stage procedures for PJI are reimbursed at approximately 1/3 the hourly rate of a primary procedure. This may discourage surgeons from selecting this treatment alternative if studies confirm efficacy. Payers should be encouraged to reimburse physicians commensurate with the intraoperative service time needed to perform a 1-stage procedure as adoption will decrease morbidity and save the healthcare system financially

The October 2024 Research Roundup³⁶⁰ looks at: Fracture risk among stroke survivors according to post-stroke disability status and stroke type; Noise-induced hearing loss: should surgeons be wearing ear protection during primary total joint replacement?; Intravenous dexamethasone in hip arthroscopy can enhance recovery; Patient-reported outcomes following periprosthetic joint infection of the hip and knee: a longitudinal, prospective observational study; When should surgery take place after weight loss?; Which type of surgery is the hardest physically and mentally?

The August 2024 Knee Roundup³⁶⁰ looks at: Calcification’s role in knee osteoarthritis: implications for surgical decision-making; Lower complication rates and shorter lengths of hospital stay with technology-assisted total knee arthroplasty; Revision surgery: the hidden burden on surgeons; Are preoperative weight loss interventions worthwhile?; Total knee arthroplasty with or without prior bariatric surgery: a systematic review and meta-analysis; Aspirin triumphs in knee arthroplasty: a decade of evidence; Efficacy of DAIR in unicompartmental knee arthroplasty: a glimpse from Oxford.

Aims

COVID-19-related patient care delays have resulted in an unprecedented patient care backlog in the field of orthopaedics. The objective of this study is to examine orthopaedic provider preferences regarding the patient care backlog and financial recovery initiatives in response to the COVID-19 pandemic.

Aims

It has previously been shown that higher-volume hospitals have better outcomes following revision total knee arthroplasty (rTKA). We were unable to identify any studies which investigated the effect of surgeon volume on the outcome of rTKA. We sought to investigate whether patients of high-volume (HV) rTKA surgeons have better outcomes following this procedure compared with those of low-volume (LV) surgeons.

Aims

Advances in surgical technique and implant design may influence the incidence and mechanism of failure resulting in revision total hip arthroplasty (rTHA). The purpose of the current study was to characterize aetiologies requiring rTHA, and to determine whether temporal changes existed in these aetiologies over a ten-year period.