Hebert CK, et al., Clinical Orthopaedics and Related Research 1996; 331, pp 140-145.
Twenty consecutive cases of infected total knee replacements surgically treated between 1990 and 1993 in which complete clinical and financial data were available were reviewed to determine the resources required of the hospital and the surgeon. These results were compared with a similar analysis of a stratified, unselected sample 30 cases each of primary total knee arthroplasty and nonseptic revision total knee arthroplasty during the same period. Parameters compared between the infected total knee replacement, noninfected revision total knee replacement, and primary total knee replacement included number of surgical procedures performed, number of hospitalizations, number of hospital days, total operative time, and total intraoperative blood loss. Financial data included the amount charged and reimbursed by the hospital and by the surgeon. The actual hospital cost was estimated as well. Based on all parameters measured, surgical treatment of the infected total knee implant required 3 to 4 times the resources of the hospital and the surgeon compared with a primary total knee implant and approximately twice the resources of a nonseptic revision total knee implant. The reimbursement received resulted in an estimated net loss of approximately $15,000 per case to the hospital for the group as a whole, but approximately $30,000 per case per Medicare patient.