{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:27:03Z","timestamp":1790746023091,"version":"4.1.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2019,5,15]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Revision total hip arthroplasty (revision THA) occurs for a wide variety of indications and in the United States it is coded under Diagnosis-Related Groups (DRGs) 466, 467, and 468, which do not account for revision etiology, a potentially substantial driver of cost. This study investigates revision THA costs and 30-day complications by indication, both locally and nationally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Hospitalization costs and complication rates for 1,422 aseptic revision THAs performed at a high-volume center between 2009 and 2014 were retrospectively reviewed. Additionally, charges for 28,133 revision THAs in the National Inpatient Sample (NIS) were converted to costs using the Healthcare Cost and Utilization Project cost-to-charge ratios, and 30-day complication rates for 3,224 revision THAs were obtained with use of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Costs and complications were compared between revision THAs performed for fracture, wear\/loosening, and dislocation\/instability with use of simultaneous and pairwise comparisons and a multivariable model accounting for American Society of Anesthesiologists (ASA) score, age, and sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Local hospitalization costs for fracture (median, $25,672) were significantly higher than those for wear\/loosening ($20,228; p &lt; 0.001) or dislocation\/instability ($17,911; p &lt; 0.001), with differences remaining significant even after adjusting for patient comorbidities (p &lt; 0.001). NIS costs for fracture (median, $27,596) were higher than those for other aseptic indications (wear\/loosening: $21,176, p &lt; 0.001; dislocation\/instability: $16,891, p&lt; 0.001). Local 30-day orthopaedic complication rates for fracture (20.7%) were higher those than for dislocation\/instability (9.0%; p = 0.007) and similar to those for wear\/loosening (17.6%; p = 0.434). Nationally, combined medical and surgical complication rates for fracture (71.3% of patients with \u22651 complication) were significantly higher than those for wear\/loosening (35.2%; p &lt; 0.001) or dislocation\/instability (35.1%; p &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Hospitalization costs for revision THA for fracture were 33% to 48% higher than for all other aseptic revision THAs, both locally and nationally. This increased cost persisted even after multivariable comorbidity adjustment, the current DRG basis for stratifying revision THA reimbursement. Additionally, 30-day complication rates suggest that increased resource utilization for fracture patients continues even after discharge. Indication-specific coding and reimbursement systems are necessary to maintain sustainable access to revision THA for all patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.18.00523","type":"journal-article","created":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T07:28:43Z","timestamp":1557991723000},"page":"912-919","source":"Crossref","is-referenced-by-count":38,"title":["Revision Total Hip Arthroplasty for the Treatment of Fracture: More Expensive, More Complications, Same Diagnosis-Related Groups"],"prefix":"10.2106","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6208-878X","authenticated-orcid":false,"given":"Mario","family":"Hevesi","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8629-7567","authenticated-orcid":false,"given":"Cody C.","family":"Wyles","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1179-7142","authenticated-orcid":false,"given":"Jie J.","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3882-602X","authenticated-orcid":false,"given":"Hilal","family":"Maradit-Kremers","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1140-003X","authenticated-orcid":false,"given":"Elizabeth B.","family":"Habermann","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7763-3100","authenticated-orcid":false,"given":"Amy E.","family":"Glasgow","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0527-0881","authenticated-orcid":false,"given":"Katherine A.","family":"Bews","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2131-1970","authenticated-orcid":false,"given":"Jeanine E.","family":"Ransom","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0027-491X","authenticated-orcid":false,"given":"Sue L.","family":"Visscher","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3101-9129","authenticated-orcid":false,"given":"David G.","family":"Lewallen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1422-0306","authenticated-orcid":false,"given":"Daniel J.","family":"Berry","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery (M.H., C.C.W., J.J.Y., H.M.-K., D.G.L., and D.J.B.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program (E.B.H., A.E.G., and K.A.B.), and the Department of Health Sciences Research (H.M.-K., J.E.R., and S.L.V.), Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"6","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1377\/hlthaff.27.6.1587","article-title":"Hip and knee implants: current trends and policy considerations","volume":"27","author":"Wilson","year":"2008","journal-title":"Health Aff (Millwood)."},{"issue":"4","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"780","DOI":"10.2106\/00004623-200704000-00012","article-title":"Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030","volume":"89","author":"Kurtz","year":"2007","journal-title":"J Bone Joint Surg Am."},{"issue":"17","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.2106\/JBJS.N.01141","article-title":"Prevalence of total hip and knee replacement in the united states","volume":"97","author":"Maradit Kremers","year":"2015","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib7-20230810","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/s00264-007-0364-3","article-title":"Total hip arthroplasties: what are the reasons for revision?","volume":"32","author":"Ulrich","year":"2008","journal-title":"Int Orthop."},{"issue":"1","key":"bib8-20230810","doi-asserted-by":"crossref","first-page":"27","DOI":"10.2106\/00004623-200301000-00005","article-title":"Rates and outcomes of primary and revision total hip replacement in the United States medicare population","volume":"85-A","author":"Mahomed","year":"2003","journal-title":"J Bone Joint Surg Am."},{"issue":"7","key":"bib9-20230810","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1016\/j.arth.2017.02.046","article-title":"Current epidemiology of revision total hip arthroplasty in the united states: National Inpatient Sample 2009 to 2013","volume":"32","author":"Gwam","year":"2017","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib10-20230810","first-page":"82","article-title":"Changing indications for revision total hip arthroplasty","volume":"14","author":"Lachiewicz","year":"2005","journal-title":"J Surg Orthop Adv."},{"issue":"429","key":"bib11-20230810","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1097\/01.blo.0000150126.73024.42","article-title":"Reasons for revision hip surgery: a retrospective review","author":"Clohisy","year":"2004","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib12-20230810","doi-asserted-by":"crossref","first-page":"128","DOI":"10.2106\/JBJS.H.00155","article-title":"The epidemiology of revision total hip arthroplasty in the United States","volume":"91","author":"Bozic","year":"2009","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib13-20230810","doi-asserted-by":"crossref","first-page":"393","DOI":"10.5435\/JAAOS-D-15-00596","article-title":"The epidemiology of primary and revision total hip arthroplasty in teaching and nonteaching hospitals in the United States","volume":"24","author":"Kowalik","year":"2016","journal-title":"J Am Acad Orthop Surg."},{"issue":"344","key":"bib14-20230810","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1097\/00003086-199711000-00007","article-title":"Maintaining a hip registry for 25 years. 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