Abstract
Total hip arthroplasty (THA) performed in the setting of fracture is associated with
greater case complexity, worse outcomes, and increased costs when compared with THA
performed for osteoarthritis. Despite the increased complexity, the work relative
value units (wRVUs) assigned to THA may not adequately compensate for this difference
in surgical effort and time. The purpose of this study was to determine the wRVU per
minute rates and reimbursement in dollars per minute for THA performed for fracture
compared with THA performed for osteoarthritis. Data were collected through the National
Surgical Quality Improvement Program database from 2006 to 2018 to identify all patients
who underwent primary THA for osteoarthritis or for fractures. Total wRVU, operation
time, wRVU per minute, and dollars per minute were assessed between the osteoarthritis
and fracture cohorts. Bivariate and multivariate analyses were utilized for the study.
The mean operation times for primary THA for osteoarthritis and for fractures were
91.96 and 99.43 minutes, respectively (p < 0.001), resulting in 0.26 versus 0.25 wRVU/min (p < 0.001). THA for osteoarthritis was also valued higher at $9.22/min versus $8.83/min
for fracture (p < 0.001). This study shows that wRVU rates and reimbursement in dollars per minute
for THA performed in the setting of fracture were lower than THA performed for osteoarthritis.
Although patient care remains the number one priority, these findings have important
implications in establishing adequate compensation for more complex cases. Level of
evidence is III.
Keywords
primary THA - osteoarthritis - fracture - relative value units - operation time
