Diagnosis and Treatment Influence Hospital Costs of Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.

Abstract

Background: This systematic review and meta-analysis aimed to synthesize the hospital costs of revision total hip arthroplasty (rTHA) by periprosthetic joint infection (PJI), periprosthetic fracture (PPF), aseptic loosening, and recurrent dislocation diagnoses. Additionally, as several surgical options are available within some diagnoses, this study aimed to synthesize the evidence on hospital costs for septic rTHA between debridement and implant retention (DAIR), one-stage and two-stage rTHA, and for PPF the cost between rTHA and open reduction internal fixation (ORIF) treatment.

Methods: A systematic search of PubMed, Embase, and Scopus identified all studies reporting the hospital costs of rTHA. Screening, data extraction, and risk of bias assessment were conducted. Hospital costs of each study cohort by main diagnosis and treatment were adjusted to 2024 USD and pooled using a random effects model.

Results: Of 866 publications identified, 24 studies were included in the meta-analysis. Mean pooled costs of rTHA for dislocation, aseptic loosening, PPF, and septic rTHA were $25,256, $34,533, $35,904, and $55,707, respectively. The mean cost of septic rTHA (16 study cohorts) at $57,264 was 87% higher than aseptic rTHA (22 cohorts) at $30,224. A two-stage septic rTHA ($70,311) cost 77% more than one-stage septic rTHAs ($39,676). The cost of rTHA for PPF ($35,904) was 26% more than ORIF for PPF ($28,410).

Conclusion: The cost of rTHA is progressively higher by diagnosis in the order of dislocation, aseptic loosening, PPF, and infection. Future studies should separately report rTHA costs by diagnosis and treatment type and longitudinally examine the hospital costs of this patient cohort, particularly for septic cases, beyond initial treatment to better understand the burden of rTHA.