Etiology and assessment of cost-effectiveness of revision hip arthroplasty

Aim: We aimed to compare the reasons for primary and revision hip arthroplasty operated in the Department of Orthopedics and Traumatology, Ankara University Faculty of Medicine, the cost profiles of these patients, and to evaluate the impact of hospital stay, comorbidities, septic and aseptic revision rates on cost. Materials and Methods: Among the Social Security Institution surgery codes operated in our clinic between January 2017 and December 2022, P612480 (hip revision arthroplasty, total) and P612470 (hip arthroplasty, acetabular liner replacement, total), P612471 (hip acetabular revision, partial), p612472 (hip femoral stem revision, Patients who entered the code numbered P12340 (partial) and P12340 (total hip joint prosthesis) were included in the study. 205 patients who underwent revision total hip arthroplasty and 737 patients who underwent primary hip arthroplasty were included in the study. Patients' information and cost documentation for revision and primary hip arthroplasty operations were accessed from the billing unit of our hospital's information operating system. Results: While the median cost of revision cases in 6 years was 15069.77 Turkish lira (TL), this amount was 8716.47 TL in primary hip arthrplasty and this rate was statistically significant (p˂0.001). When compared by year, the costs of revision cases are higher every year. The statistical significance varied (p:0.335 for 2017, p˂0.001 for 2018, p˂0.001 for 2019, p˂0.001 for 2020, p:0.238 for 2021, p˂0.001 for 2022). There was a significant difference in cost between septic and aseptic causes (p˂0.001) and between periprosthetic fractures and aseptic causes (p:0.02). Conclusions: Revision hip arthroplasty carries a higher cost burden than primary hip arthroplasty. Therefore, it is important to determine preoperative risk factors and increase arthroplasty survival. We hope that this study will contribute to raising awareness on this issue and the development of a national registry system.