Revision Joint Arthroplasty is Costly and Leads to Less Desirable Outcomes
In this post we would like to talk about revision joint arthroplasty (replacement). This is when a patient has already received a primary total joint arthroplasty, most commonly a knee or hip replacement, and then due to complications must go in for a follow up surgery to fix an issue in the artificial joint. Most people who get a joint replacement will not have to deal with a revision. Modern joint replacement procedures are very successful and frequently performed surgeries. Despite that fact, researchers project that even as surgical techniques and implant design improves, the number of revision arthroplasty procedures is still expected to grow due to the increase in procedure volume. The most common factors that would lead to a revision joint arthroplasty are instability, aseptic loosening, and infection. There are many reasons to want to avoid getting a revision, but two of the main ones are the increased cost associated with revision surgery, as well as the decreased opportunity for a desirable outcome.
A study published in 2018 evaluated the additional costs as well as other side effects associated with revision surgery. They found that, on average, the operation time was 52 minutes longer for a revision total joint replacement than the primary joint replacement counterpart. They also found an increase in the average hospital stay to be an additional 4 days. All of the factors associated with the revision surgery resulted in a higher financial expense of 76.0%. This was due to higher implant costs, perioperative costs, and longer hospital stays. There was a higher reimbursement for revision surgery, however, it only covered a small part of the elevated expenses. What’s worse is that the cost of revision surgery is steadily rising. There has been a 300% increase of overall costs associated with revision hip arthroplasty within a ten year period.
As far as functional outcomes are concerned, just because someone has a revision joint arthroplasty, doesn’t mean that they will be disabled. Several studies still confirm major improvements in function and reduction in joint pain no matter if it’s a primary joint arthroplasty or a revision. What it does mean is that the likelihood of a comparable outcome to a patient receiving a primary joint replacement is scarce. Revision surgery is a complex and challenging procedure. It requires further resection of bone and additional trauma to the muscles and ligaments around the joint resulting in typically longer recovery times and potentially less optimal outcomes.
One of the common reasons for a revision is due to infection in the newly implanted joint. Unfortunately, this can happen to anyone no matter the surgeon, surgical technique, setting, etc. Revisions due to joint loosening, however, can be somewhat mitigated through more advanced surgical techniques. A study on revision rates for total hip arthroplasty between standard hip replacements and hip replacements using computer navigation, showed a clear reduction in revision rates with the computer navigation group.
The basic truth is that not everyone will be able to avoid revision joint arthroplasty. There will likely always be a small percentage of procedures that will have complications causing a revision surgery. However, what we do know is that there are methods out there that can reduce the risk for needing a revision. Advanced surgical planning and computer and technology assisted procedures are at the forefront of reducing revision rates. This will help save patients and the healthcare system significant amounts of money, as well as provide better outcomes. When considering joint replacement surgery, it’s absolutely worth it to choose a procedure that’s going to give you the best opportunity for a successful procedure and a great outcome.
To learn more about Kinomatic’s approach to advanced joint replacement procedures, click here.
Agarwal, Sujit MBBS, MS, FRCS(T&Orth)1,2,*; Eckhard, Lukas MD1,3,a,*; Walter, William L. MBBS, PhD, FRACS(Orth)4; Peng, Andrea MMed(Epi&Stats)5; Hatton, Alesha BMedMath(Hons)5; Donnelly, Bill MBBS, BMedSci, FRACS(Orth)6; de Steiger, Richard MBBS, PhD, FRACS(Orth)6,7 The Use of Computer Navigation in Total Hip Arthroplasty Is Associated with a Reduced Rate of Revision for Dislocation, The Journal of Bone and Joint Surgery: October 20, 2021 – Volume 103 – Issue 20 – p 1900-1905 doi: 10.2106/JBJS.20.00950
Postler AE, Beyer F, Wegner T, et al. Patient-Reported outcomes after Revision Surgery Compared to Primary Total Hip Arthroplasty. HIP International. 2017;27(2):180-186. doi:10.5301/hipint.5000436
Weber M, Renkawitz T, Voellner F, Craiovan B, Greimel F, Worlicek M, Grifka J, Benditz A. Revision Surgery in Total Joint Replacement Is Cost-Intensive. Biomed Res Int. 2018 Sep 25;2018:8987104. doi: 10.1155/2018/8987104. PMID: 30356391; PMCID: PMC6176320.
Postler, A., Lützner, C., Beyer, F. et al. Analysis of Total Knee Arthroplasty revision causes. BMC Musculoskelet Disord 19, 55 (2018). https://doi.org/10.1186/s12891-018-1977-y