Revision Total Hip Arthroplasty (THA) are complex procedures with varying diagnoses and treatment methods that have historically been difficult to code and cost appropriately. The aim of this study was to perform a meta-analysis of revision THA hospital costs by 1) diagnosis, 2) treatment and 3) hospital costing mechanism used.
A meta-analysis investigated the effect of diagnosis (infection, fracture, dislocation, and loosening); treatment method (DAIR, partial revision, 1-stage revision, 2-stage revision); and the reported costing mechanism calculation (Diagnosis Related Group (DRG) costing, International Classification of Diseases (ICD), US Medicare Estimated (USME) and independent cost modelling (ICM)) on reported revision THA hospital costs. All costs were adjusted for inflation and converted to AUD for statistical analysis.
The review identified 54 studies from 13 different countries. Only 14 studies reported revision THA costs by diagnosis. Six individual studies reported septic revisions to cost 69% to 193% more than aseptic revision THAs. The unadjusted pooled reported mean cost for septic revision THA was $AU94,313 (range $18,429 to $215,162) in 12 studies compared to $39,922 for aseptic revisions ($7,454 to $120,409) in 11 studies. Only one study separated aseptic revisions by diagnosis and reported the mean cost of fracture ($42,437), loosening ($33,438), and dislocation ($29,607). The cost of different treatment methods was only investigated in one study. 12 studies used USME; 11 ICM; 3 DRG, 1 ICD, and 24 studies did not report the costing mechanism calculation used.
This meta-analysis found septic revision THA costs to be on average 136% more than aseptic revisions. The large variation in reported revision THA costs is likely due to the different costing mechanism used, however the method was not reported in over half of the studies in this review. Revision THA costs need further detailed investigation to enable overburdened healthcare systems to budget appropriately.