Quantifying and Predicting Surgeon Work Effort for Primary and Revision Total Knee Arthroplasty

Abstract Background The objectives of this study were to quantify increased utilization of resources in revision total knee arthroplasty (TKA) compared to primary TKA, determining preoperative factors that predict outcome measures as well as compare Medicare reimbursement for each procedure. Methods Seventy-eight revision TKA patients were compared to 80 primary TKA patients. Outcomes measured were surgical time, estimated blood loss (EBL), length of stay, and complications. Results Revision TKA showed 49% increased surgical time compared to primary TKA. EBL was increased 91%. Tibial and femoral bone loss were associated with increased surgical time as was use of longer stemmed tibial components. Average Medicare hospital payment increased 29% ($13,464 for primary, $17,331 for revision). Average physician reimbursement represented a 36% increase. Relative value units were increased 31%. Conclusion There was substantial increase in work effort not commensurate with current Medicare reimbursement, which may limit patient access to revision TKA.