Background: Deep infection following total hip arthroplasty is a
devastating complication for the patient and a costly one for patients,
surgeons, hospitals, and payers. The purpose of this study was to compare
revision total hip arthroplasty for infection, revision total hip arthroplasty
for aseptic loosening, and primary total hip arthroplasty with respect to
their impact on hospital and surgeon resource utilization and referral
patterns to a tertiary-care hospital.
Methods: Clinical, demographic, and economic data were obtained for
twenty-five consecutive patients with an infection after a total hip
replacement who underwent a two-stage revision arthroplasty (Group 1)
performed by one of two surgeons, between March 2001 and December 2002, at a
single institution. Similar data were collected during the same time-period
for a cohort of twenty-five consecutive patients who underwent revision of
both components because of aseptic loosening (Group 2) and twenty-five
consecutive patients who underwent a primary hip arthroplasty (Group 3).
Quantitative and categorical variables were compared among the groups.
Referral patterns were examined by reviewing the primary diagnosis for all
patients referred to our institution for a revision total hip arthroplasty
during a five-year period.
Results: Revision procedures for infection were associated with
longer operative time, more blood loss, and a higher number of complications
compared with revisions for aseptic loosening or primary total hip
arthroplasty (p < 0.02 for all). Revisions for infection were also
associated with a higher total number of hospitalizations, total number of
days in the hospital, total number of operations, total hospital costs, total
outpatient visits, and total outpatient charges during the twelve-month period
following the index procedure (p < 0.001 for all). The incidence of
referrals to our institution for a diagnosis of infection following total hip
arthroplasty increased significantly over a five-year period (Spearman rank
correlation, 1.0; p = 0.0083), while referral rates for revision for causes
other than infection remained relatively constant (Spearman rank correlation,
0.500; p = 0.3910).
Conclusions: The treatment of patients with an infection after a
total hip arthroplasty is associated with significantly greater hospital and
physician resource utilization compared with the treatment of patients who
have a revision because of aseptic loosening or who have a primary total hip
arthroplasty. We believe that the lack of incremental reimbursement associated
with these procedures results in strong financial disincentives for physicians
and hospitals to provide treatment for patients with an infection after a
total hip arthroplasty.