Impact of revision TKA indications on resource utilization.

BACKGROUND

Indications for surgery may impact resource utilization in aseptic revision total knee arthroplasty (rTKA), and understanding these relationships would facilitate risk-stratification preoperatively. The purpose of this study was to investigate the impact of rTKA indications on readmission, reoperation, length of stay (LOS), and cost.

METHODS

We reviewed all 962 patients who underwent aseptic rTKA at an academic orthopedic specialty hospital between June 2011-April 2020 with at least 90 days of follow-up. Patients were categorized based on their indication for aseptic rTKA as listed in the operative report. Demographics, surgical factors, LOS, readmission, reoperation and cost were compared between cohorts.

RESULTS

There were significant differences in operative time among cohorts (p < 0.001), highest among the periprosthetic fracture group (164.2 ± 59.8 min). Reoperation rate was greatest in the extensor mechanism disruption cohort (50.0 %, p = 0.009). Total cost differed significantly among groups (p < 0.001), which was highest among the implant failure cohort (134.6 % of mean) and lowest for component malpositioning cohort (90.2 % of mean). Similarly, there were significant differences in direct cost (p < 0.001) which was highest in the periprosthetic fracture cohort (138.5 % of mean), and lowest in the implant failure cohort (90.5 % of mean). There were no differences in discharge disposition, or number of re-revisions among all groups.

CONCLUSIONS

Operative time, components revised, LOS, readmissions, reoperation rate, total cost and direct cost following aseptic rTKA varied significantly between different revision indications. These differences should be noted for preoperative planning, resource allocation, scheduling, and risk-stratification.

LEVEL OF EVIDENCE: III, retrospective observational analysis.