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Conversion hip arthroplasty is defined as a patient who has had prior open or arthroscopic hip surgery with or without retained hardware that is removed and replaced with arthroplasty components. Currently, it is classified under the same diagnosis related group (DRG) as primary total hip arthroplasty (THA), however, it frequently requires a higher cost of care.A retrospective study of 228 conversion THA procedures in an orthopaedic specialty hospital were performed. Propensity score matching was used to compare the study group to a cohort of 510 primary THA patients by age, body mass index (BMI), sex and American Society of Anesthisiology (ASA) score. These matched groups were compared based on total costs, implants used, operative times, llengths of stay (LOS), readmissions, and complications.Conversion THA incurred 25% greater mean total costs compared to primary THA (p.05), longer lengths of surgery (154 vs 122 minutes), and hospital LOS (2.1 vs 1.56 days). A subgroup analysis showed a 57% increased cost for cephalomedullary nail conversion, 34% increased cost for sliding hip screw, 33% for acetabular ORIF conversion, and 10% increased costs in closed reduction and percutaneous pinning conversions (all p.05). There were 5 intraoperative complications in the conversion group versus none in the primary THA group (P.01), with no statistically significant difference in readmissions.Conversion THA is significantly more costly than primary THA and has longer surgical times, and greater LOS. Specifically, conversion THA with retained implants had the greatest impact on cost. |
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