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The higher hospital costs of revision total hip arthroplasty by diagnosis: analysis of cost drivers and periprosthetic joint infection treatment pathways

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dc.contributor.authorHammat, A.S.
dc.contributor.authorD'Apollonio, T.
dc.contributor.authorNelson, R.
dc.contributor.authorCampbell, D.
dc.contributor.authorRamasamy, B.
dc.contributor.authorSolomon, L.B.
dc.contributor.authorGnanamanickam, E.S.
dc.contributor.authorCallary, S.A.
dc.date.issued2025
dc.description.abstractBackground: Total hip arthroplasty (THA) is recognised to improve patients' quality of life; however revision surgery incurs a substantial burden upon patients, clinicians, hospitals and healthcare systems. This study aimed to investigate (1) the hospital costs of revision THA (rTHA) relative to primary THA (pTHA) by diagnosis and the cost drivers within each episode of care (EoC); and (2) the cumulative costs of rTHA for prosthetic joint infections (PJI) by treatment pathway. Methods: Median hospital costs of patients undergoing pTHA (n = 1101) or rTHA (n = 396) at a tertiary referral hospital between 2014 and 2022 were calculated by diagnosis, cost drivers and treatment pathways. Admission and procedural data were verified across multiple hospital databases, including a prospective hospital-based arthroplasty register. Costs were adjusted for inflation to 2024 Australian Dollars (AU$). Results: Median cost of rTHA per EoC ($45 165) was significantly more costly than pTHA ($25 615, p < 0.05). Median rTHA cost by diagnosis increased from dislocation ($37 072), loosening ($47 708), periprosthetic fractures ($52 521) to PJI ($65 325). Within each diagnosis of rTHA, the most expensive cost drivers were ward-related and surgical theatre costs. Regarding PJI treatment pathways, median cost was $123 688 for two-stage rTHA, $63 261 for single stage rTHA and $51 760 for debridement and implant retention. Conclusion: Median costs of rTHA for dislocation, loosening, periprosthetic fracture and PJI were associated with a 1.5, 1.9, 2.1 and 2.6-fold higher cost relative to pTHA per EoC, respectively. Ongoing surgical treatment and readmission for PJI lead to complex treatment pathways and increased costs.
dc.identifier.citationANZ Journal of Surgery, online, 2025; online(3):1-9
dc.identifier.doi10.1111/ans.70368
dc.identifier.issn1445-1433
dc.identifier.issn1445-2197
dc.identifier.orcidHammat, A.S. [0000-0002-7283-9740]
dc.identifier.orcidD'Apollonio, T. [0009-0002-6406-0435]
dc.identifier.orcidNelson, R. [0000-0002-2051-5998]
dc.identifier.orcidCampbell, D. [0000-0002-1572-9529]
dc.identifier.orcidRamasamy, B. [0000-0003-2708-8420]
dc.identifier.orcidSolomon, L.B. [0000-0001-6254-2372]
dc.identifier.orcidGnanamanickam, E.S. [0000-0002-8284-4746]
dc.identifier.orcidCallary, S.A. [0000-0002-2892-5238]
dc.identifier.urihttps://hdl.handle.net/11541.2/45414
dc.language.isoen
dc.publisherJohn Wiley & Sons
dc.rights© 2025 Royal Australasian College of Surgeons
dc.source.urihttps://doi.org/10.1111/ans.70368
dc.titleThe higher hospital costs of revision total hip arthroplasty by diagnosis: analysis of cost drivers and periprosthetic joint infection treatment pathways
dc.typeJournal article
pubs.publication-statusPublished
ror.mmsid9917086844301831

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