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BioMed Research International
Volume 2018, Article ID 8987104, 8 pages
Research Article

Revision Surgery in Total Joint Replacement Is Cost-Intensive

1Department of Orthopaedic Surgery, Regensburg University Medical Center, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077 Bad Abbach, Germany
2Department of Trauma Surgery, Regensburg University Medical Center, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany

Correspondence should be addressed to Markus Weber;

Received 27 May 2018; Accepted 2 August 2018; Published 25 September 2018

Academic Editor: Konstantinos Anagnostakos

Copyright © 2018 Markus Weber et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Revisions after total joint replacement increase constantly. In the current study, we analyzed clinical outcome, complication rates, and cost-effectiveness of revision arthroplasty. In a retrospective analysis of 162 revision hip and knee arthroplasties from our institutional joint registry responder rate, patient-reported outcome measures (EQ-5D, WOMAC), complication rates, and patient-individual charges in relation to reimbursement were compared with a matched control group of primary total joint replacements. Positive responder rate one year postoperatively was lower for revision arthroplasties with 72.9% than for primary arthroplasties with 90.1% (OR=0.30, 95%CI=0.18–0.59, p=0.001). Correspondingly, improvement in patient-reported outcome measures one year after surgery was lower in revision than in primary joint arthroplasty with EQ-5D 0.19±0.25 to 0.30±0.24 (p<0.001) and WOMAC 24.3±30.3 to 41.2±21.3 (p<0.001). Infection rate was higher in revision (6.8%) compared to primary replacements (0%, p=0.001). Mean charges in revision arthroplasty were 76.0% higher than in matched primary joint replacements (7110.8±2249.4$ to 4041.1±975.7$, p<0.001), whereas reimbursement was only 23.6% higher (9243.3±2258.4$ in revision and 7477.9±703.1$ in primary arthroplasty, p<0.001). Revision arthroplasty is associated with lower outcome and higher infection rate compared to primary replacements. The high financial expense of revision arthroplasty is only partly covered by a higher reimbursement.