title: A financial analysis of revision hip arthroplasty: the economic burden in relation to the national tariff.
abstract: Revision arthroplasty of the hip is expensive owing to the increased cost of pre-operative investigations, surgical implants and instrumentation, protracted hospital stay and drugs. We compared the costs of performing this surgery for aseptic loosening, dislocation, deep infection and peri-prosthetic fracture. Clinical, demographic and economic data were obtained for 305 consecutive revision total hip replacements in 286 patients performed at a tertiary referral centre between 1999 and 2008. The mean total costs for revision surgery in aseptic cases (n = 194) were £11 897 (sd 4629), for septic revision (n = 76) £21 937 (sd 10 965), for peri-prosthetic fracture (n = 24) £18 185 (sd 9124), and for dislocation (n = 11) £10 893 (sd 5476). Surgery for deep infection and peri-prosthetic fracture was associated with longer operating times, increased blood loss and an increase in complications compared to revisions for aseptic loosening. Total inpatient stay was also significantly longer on average (p < 0.001). Financial costs vary significantly by indication, which is not reflected in current National Health Service tariffs.
authors.affiliation: University College Hospital London NHS Trust, Orthopaedic Surgery Department, 235 Euston Road, London NW1 2BU, UK.
authors.forename: I S
authors.initials: IS
authors.lastname: Vanhegan
authors.forename: A K
authors.initials: AK
authors.lastname: Malik
authors.forename: P
authors.initials: P
authors.lastname: Jayakumar
authors.forename: S
authors.initials: S
authors.lastname: Ul Islam
authors.forename: F S
authors.initials: FS
authors.lastname: Haddad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000191:economics*; D005260:Female; D006302:Health Services Research / Q000379:methods; D006617:Hip Dislocation / Q000191:economics / Q000209:etiology / Q000601:surgery; D006622:Hip Prosthesis / Q000009:adverse effects / Q000191:economics; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008131:London; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000191:economics / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000191:economics / Q000601:surgery; D012052:Reimbursement, Incentive / Q000706:statistics & numerical data*; D012086:Reoperation / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D013222:State Medicine / Q000191:economics; D055815:Young Adult