The Lawrence D. Dorr Surgical Techniques &amp; Technologies Award: Conversion Total Hip Arthroplasty: Is it a Primary or Revision Hip Arthroplasty

Baghoolizadeh, Mahta; Schwarzkopf, Ran

doi:10.1016/j.arth.2015.06.024

Cited by 53 publications

(32 citation statements)

References 22 publications

(24 reference statements)

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“…Patients undergoing conversion THA had longer hospital stays and incurred greater costs than primary THA, but were similar to revision THA. Previous studies [3,8] have highlighted that conversion THA uses more hospital resources and has a complication profile more similar to revision THA, but to the authors' knowledge studies have not shown that the cost of conversion THA is similar to that of revision THA. Institutions should strive for conversion THA after hemiarthroplasty to receive reimbursement at the level of a revision procedure and not as a primary procedure.…”

Section: Discussionmentioning

confidence: 85%

“…Previous studies also have found that conversion THAs receive more revision-type implants than the primary THAs, and they were similar to revision THAs [3,13,14]. These studies did not specifically evaluate conversion after just hemiarthroplasty [3,13,14]. Further, few studies have evaluated the costs of conversion THA after hemiarthroplasty and compared these costs directly to primary and revision THA [5].…”

Section: Introductionmentioning

confidence: 99%

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Conversion of Hemiarthroplasty to THA Carries an Increased Risk of Reoperation Compared With Primary and Revision THA

Hernandez

Fruth

Larson

et al. 2019

Clin Orthop Relat Res

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Background There is limited information on the complications and costs of conversion THA after hemiarthroplasty for femoral neck fractures. Previous studies have found that patients undergoing conversion THA experience higher risk complications, but it has been difficult to quantify the risk because of small sample sizes and a lack of comparison groups. Therefore, we compared the complications of patients undergoing conversion THA with strictly matched patients undergoing primary and revision THA. Questions/purposes (1) What are the risks of complications, dislocations, reoperations, revisions and periprosthetic fractures after conversion THA compared with primary and revision THA and how has this effect changed over time? (2) What are the length of hospital stay and hospital costs for conversion THA, primary THA, and revision THA? Methods Using a longitudinally maintained total joint registry, we identified 389 patients who were treated with conversion THA after hemiarthroplasty for femoral neck fractures between 1985 and 2014. The conversion THA cohort was 1:2 matched on age, sex, and year of surgery to 778 patients undergoing primary THA and 778 patients undergoing revision THA. The proportion of patients having at least 5-year followup was 73% in those who underwent conversion THA, 77% in those who underwent primary THA, and 76% in those who underwent revision THA. We observed a significant calendar year effect, and therefore, compared the three groups across two separate time periods: 1985 to 1999 and 2000 to 2014. We ascertained complications, dislocations, reoperations, revisions and periprosthetic fractures from the total joint registry. Cost analysis was performed using a bottom-up, microcosting methodology for procedures between 2003 and 2014. Results Patients who converted to THA between 1985 and 1999 had a higher risk of complications (hazard ratio [HR

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Conversion of Hemiarthroplasty to THA Carries an Increased Risk of Reoperation Compared With Primary and Revision THA

Hernandez

Fruth

Larson

et al. 2019

Clin Orthop Relat Res

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show abstract

“…Although there have not been many studies investigating conversion THAs, results that have been published are reminiscent of the evidence that ultimately led to a separate classification for revision THA apart from primary THA [5,12,14,18–22,37]. We hope that the results of this study will provide the impetus for the medical community and the CMS to collaborate in removing any barriers preventing patients in need of a conversion THA from getting the care that they need.…”

Section: Discussionmentioning

confidence: 99%

Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis

Chin

Wright

Snir³

et al. 2016

The Journal of Arthroplasty

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Introduction Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA. Methods Fifty-one consecutive conversion THA patients (Current Procedure Terminology code 27132) and 105 matched primary THA patients (Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis. Results Conversion and primary THAs were determined to be significantly different (P < .05) and greater in the following costs: hospital operating direct cost (29.2% greater), hospital operating total cost (28.8% greater), direct hospital cost (24.7% greater), and total hospital cost (26.4% greater). Conclusions Based on greater hospital operating direct cost, hospital operating total cost, direct hospital cost, and total hospital cost, conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA.

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“…Schwarzkopf et al . found that THA after the failure of hip fracture internal fixation had greater postoperative infection incidence than primary THA. Gallo et al .…”

Section: Discussionmentioning

confidence: 99%

One‐Stage Arthroplasty or Revision for Seronegative Infections in Hip and Knee

et al. 2019

Orthopaedic Surgery

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Objective To assess the safety and effectiveness of one‐stage total joint arthroplasty (TJA) or revision for seronegative infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods This retrospective study included a total of 495 patients who had undergone one‐stage total joint (hip or knee) arthroplasty or revision with a diagnosis of osteoarthritis secondary to sepsis, osteoarthritis or osteonecrosis of the femoral head (ONFH) secondary to internal fixation surgery of the hip joint, and one‐stage revision for prosthesis loosening after THA or TKA from January 2012 to December 2016. Bacterial cultures were taken from all patients (from joint fluid or articular cavity fluid and four to six different parts of soft tissues) during the operation. If the cultures were positive, patients received antibiotic treatment. Microbiology results from surgical samples, clinical evaluations, SF‐12 score (physical component summary [PCS] and mental component summary [MCS]), Harris hip score (HHS) or Hospital for Special Surgery (HSS) score, and patients' satisfaction was recorded at every follow‐up session. Results A total of 24 patients had a positive result for bacterial culture (4.85%). The bacterial culture results showed that there were 19 cases (79.16%) of gram‐positive cocci (Staphylococcus aureus), 4 cases (16.67%) of gram‐negative bacilli, and 1 case (4.17%) of fungi. For at least 24 months (mean 35 months) follow‐up, no reinfection was discovered. The mean HHS or HSS score improved significantly from 36.29 points preoperatively to 84.21 points postoperatively (P < 0.001). The mean PCS score improved from 10.15 preoperatively to 20.34 postoperatively, and the mean MCS from 13.22 preoperatively to 21.76 postoperatively, with significant differences. Most of the patients were satisfied. Conclusion One‐stage arthroplasty or revision with exhaustive debridement, adequate dosage, and duration of sensitive antibiotics is safe and effective for patients who have seronegative infection of hip or knee joints.

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The Lawrence D. Dorr Surgical Techniques & Technologies Award: Conversion Total Hip Arthroplasty: Is it a Primary or Revision Hip Arthroplasty

Cited by 53 publications

References 22 publications

Conversion of Hemiarthroplasty to THA Carries an Increased Risk of Reoperation Compared With Primary and Revision THA

Conversion of Hemiarthroplasty to THA Carries an Increased Risk of Reoperation Compared With Primary and Revision THA

Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis

One‐Stage Arthroplasty or Revision for Seronegative Infections in Hip and Knee

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