Skip to main content
Journal cover image

Conversion Total Knee Arthroplasty: A Distinct Surgical Procedure With Increased Resource Utilization.

Publication ,  Journal Article
Bergen, MA; Ryan, SP; Hong, CS; Bolognesi, MP; Seyler, TM
Published in: J Arthroplasty
July 2019

BACKGROUND: Current Procedural Terminology coding currently makes no distinction between primary total knee arthroplasty (TKA) and conversion TKA, in which periarticular hardware components must be removed prior to or during TKA. We hypothesize that conversion TKA will carry increased operative time, blood loss, postoperative complications, and 90-day emergency department/readmission rate compared to primary TKA. METHODS: Patients undergoing conversion TKA from 2005 to 2017 were identified from an institutional database and matched to primary TKA patients by age, gender, American Society of Anesthesiologists score, body mass index, and procedure date (±1 year). Intraoperative data and 90-day postoperative complications were compared between groups. RESULTS: One hundred nine conversion TKA patients with periarticular hardware were removed prior to (n = 51) or during (n = 58) TKA and 109 primary TKA control patients were included. Conversion TKA was associated with increased tourniquet time (91 vs 71 minutes, P < .001), operative time (147 vs 113 minutes, P < .001), blood loss (225 vs 176 mL, P = .010), 90-day readmissions (14.6% vs 4.2%, P = .020), wound complication (5.6% vs 0.0%, P = .025), periprosthetic joint infection (7.9% vs 0.0%, P = .005), irrigation/debridement (9.0% vs 1.1%, P = .016), and a trend toward increased mechanical complication (6.7% vs 1.1%, P = .058). Timing of hardware removal did not affect intraoperative or postoperative outcomes. CONCLUSION: Conversion TKA is associated with higher operative time, blood loss, readmission rate, and postoperative complications compared to primary TKA. Without a proper billing code and appropriate reimbursement level to match the expected operative and postacute resource utilization by these cases, physicians may be disincentivized to perform these operations.

Duke Scholars

Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

July 2019

Volume

34

Issue

7S

Start / End Page

S114 / S120

Location

United States

Related Subject Headings

  • Tibia
  • Risk
  • Postoperative Period
  • Postoperative Complications
  • Osteotomy
  • Orthopedics
  • Operative Time
  • Middle Aged
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Bergen, M. A., Ryan, S. P., Hong, C. S., Bolognesi, M. P., & Seyler, T. M. (2019). Conversion Total Knee Arthroplasty: A Distinct Surgical Procedure With Increased Resource Utilization. J Arthroplasty, 34(7S), S114–S120. https://doi.org/10.1016/j.arth.2019.01.070
Bergen, Michael A., Sean P. Ryan, Cierra S. Hong, Michael P. Bolognesi, and Thorsten M. Seyler. “Conversion Total Knee Arthroplasty: A Distinct Surgical Procedure With Increased Resource Utilization.J Arthroplasty 34, no. 7S (July 2019): S114–20. https://doi.org/10.1016/j.arth.2019.01.070.
Bergen MA, Ryan SP, Hong CS, Bolognesi MP, Seyler TM. Conversion Total Knee Arthroplasty: A Distinct Surgical Procedure With Increased Resource Utilization. J Arthroplasty. 2019 Jul;34(7S):S114–20.
Bergen, Michael A., et al. “Conversion Total Knee Arthroplasty: A Distinct Surgical Procedure With Increased Resource Utilization.J Arthroplasty, vol. 34, no. 7S, July 2019, pp. S114–20. Pubmed, doi:10.1016/j.arth.2019.01.070.
Bergen MA, Ryan SP, Hong CS, Bolognesi MP, Seyler TM. Conversion Total Knee Arthroplasty: A Distinct Surgical Procedure With Increased Resource Utilization. J Arthroplasty. 2019 Jul;34(7S):S114–S120.
Journal cover image

Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

July 2019

Volume

34

Issue

7S

Start / End Page

S114 / S120

Location

United States

Related Subject Headings

  • Tibia
  • Risk
  • Postoperative Period
  • Postoperative Complications
  • Osteotomy
  • Orthopedics
  • Operative Time
  • Middle Aged
  • Male
  • Humans