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Hospital Cost of Dislocation After Primary Total Hip Arthroplasty
Joaquin Sanchez-Sotelo, MD, PhD, FEBOT1; George J. Haidukewych, MD2; Carol J. Boberg, RN1
1 Department of Orthopedic Surgery (J.S.-S.) and Section of Operational Analysis (C.J.B.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for J. Sanchez-Sotelo: sanchezsotelo.joaquin@mayo.edu
2 Florida Orthopaedic Institute, 13060 Telecom Parkway North, Tampa, FL 33637
View Disclosures and Other Information
Note: The authors thank Dr. B.F. Morrey for his suggestions during the completion of this study and his careful review of the manuscript.
The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopedic Surgery and the Section of Operational Analysis, Mayo Clinic, Rochester, Minnesota

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Feb 01;88(2):290-294. doi: 10.2106/JBJS.D.02799
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Background: The treatment of dislocation following primary total hip arthroplasty usually requires the use of expensive hospital resources and sometimes requires revision surgery. The hospital costs associated with treating this complication have not been previously analyzed, to our knowledge. The purpose of this study was to assess the financial impact of treating dislocations at our institution.

Methods: Between 1997 and 2001, 3671 patients underwent a total of 4054 consecutive primary total hip arthroplasties at our institution. The patients were prospectively followed at regular intervals, and their follow-up data were recorded in an institutional total joint registry. Ninety-nine hips (2.4%) in ninety-nine patients dislocated. The costs to our institution to treat these dislocations were evaluated by determining the cost of each treatment episode required to reestablish hip stability and were expressed as the percent increase in cost compared with that of an uncomplicated primary total hip replacement.

Results: Of the ninety-nine hips that dislocated, sixty-two (63%) remained stable after one or more closed reductions and thirty-seven (37%) ultimately required revision surgery. The hospital cost of each closed reduction episode represented 19% of the hospital cost of an uncomplicated total hip replacement. When revision surgery was eventually needed, the average hospital costs of one or more closed reductions and the subsequent revisions represented 148% of the hospital cost of an uncomplicated primary total hip replacement.

Conclusions: Dislocation after primary hip replacement continues to be a prevalent and costly complication that diminishes the cost-effectiveness of an otherwise very successful surgical procedure.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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