Is Conversion Total Knee Arthroplasty a Distinct Surgical Procedure? A Comparison to Primary and Revision Total Knee Arthroplasty

Abstract

Conversion total knee arthroplasty (TKA) is suggested to incur similar complication rates to revision arthroplasties. However, current billing codes do not allow for the differentiation between this operation and primary TKAs. Therefore, the purpose of this study was to compare outcomes of these two surgeries, as well as revision TKAs. Specifically, we analyzed (1) medical complications, (2) surgical complications, and (3) revision rates at 90 days and 1 year. We queried a national, all-payer database to identify patients who underwent TKA without prior implants (n = 1,358,767), required conversion TKA (n = 15,378), and who underwent revision TKA (n = 33,966) between January 1, 2010, and April 30, 2020. Conversion TKA patients (prior implant removal) were identified using the Current Procedural Terminology (CPT) codes. Outcomes studied included 30-day readmission rates and 90-day, as well as 1-year, medical and surgical complications. Conversion TKAs had greater 30-day readmission rates and incidences of most of the complications studied when compared with primary TKAs. The majority of outcomes when comparing between primary, conversion, and revision TKAs were significantly different (p < 0.01). In contrast, conversion TKA complications were similar to revision TKA. Conversion TKAs have higher postoperative complications than primary TKAs and share more similarities with revision TKAs. Thus, the lack of billing codes differentiating conversion and primary TKAs creates a challenge for orthopaedic surgeons.

Keywords

total knee arthroplasty - conversion - primary - revision - comparison

Publikationsverlauf

Eingereicht: 09. Februar 2022

Angenommen: 26. April 2022

Artikel online veröffentlicht:
07. Juli 2022

• References

• 1 Sloan M, Lee GC. Is conversion TKA a primary or revision? Clinical course and complication risks approximating revision TKA rather than primary TKA. J Arthroplasty 2021; 36 (08) 2685-2690.e1
• 2 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; 34 (7S): S114-S120
• 3 Papadopoulos EC, Parvizi J, Lai CH, Lewallen DG. Total knee arthroplasty following prior distal femoral fracture. Knee 2002; 9 (04) 267-274
• 4 Weiss NG, Parvizi J, Trousdale RT, Bryce RD, Lewallen DG. Total knee arthroplasty in patients with a prior fracture of the tibial plateau. J Bone Joint Surg Am 2003; 85 (02) 218-221
• 5 Song SJ, Bae DK, Kim II KI, Lee CH. Conversion total knee arthroplasty after failed high tibial osteotomy. Knee Surg Relat Res 2016; 28 (02) 89-98
• 6 Piedade SR, Pinaroli A, Servien E, Neyret P. TKA outcomes after prior bone and soft tissue knee surgery. Knee Surgery Sports Traumatol Arthrosc 2013; 21 (12) 2737-2743
• 7 Yayac M, Stein J, Deirmengian GK, Parvizi J, Courtney PM. Conversion total knee arthroplasty needs its own diagnosis-related group code. J Arthroplasty 2019; 34 (10) 2308-2312
• 8 Kreitz TM, Deirmengian CA, Penny GS, Maltenfort MG, Deirmengian GK. A current procedural terminology code for “knee conversion” is needed to account for the additional surgical time required compared to total knee arthroplasty. J Arthroplasty 2017; 32 (01) 20-23
• 9 Yayac MF, Harrer SL, Deirmengian GK, Parvizi J, Courtney PM. Conversion total knee arthroplasty is associated with increased post-acute care costs. J Arthroplasty 2019; 34 (12) 2855-2860
• 10 Liddle AD, Judge A, Pandit H, Murray DW. Erratum: Adverse outcomes after total and unicompartmental knee replacement in 101 330 matched patients: a study of data from the National Joint Registry for England and Wales [The Lancet (2014) 384 (1437–45)]. Lancet 2015; 385 (9970): 774
• 11 Ji JH, Park SE, Song IS, Kang H, Ha JY, Jeong JJ. Complications of medial unicompartmental knee arthroplasty. Clin Orthop Surg 2014; 6 (04) 365-372
• 12 Douglas SJ, Remily EA, Sax OC, Pervaiz SS, Delanois RE, Johnson AJ. How does conversion total hip arthroplasty compare to primary?. J Arthroplasty 2021; 36 (7S): S155-S159
• 13 Navathe AS, Troxel AB, Liao JM. et al. Cost of joint replacement using bundled payment models. JAMA Intern Med 2017; 177 (02) 214-222
• 14 Barnett ML, Wilcock A, McWilliams JM. et al. Two-year evaluation of mandatory bundled payments for joint replacement. N Engl J Med 2019; 380 (03) 252-262
• 15 Bala A, Penrose CT, Seyler TM, Mather III RC, Wellman SS, Bolognesi MP. Outcomes after total knee arthroplasty for post-traumatic arthritis. Knee 2015; 22 (06) 630-639
• 16 Suzuki G, Saito S, Ishii T, Motojima S, Tokuhashi Y, Ryu J. Previous fracture surgery is a major risk factor of infection after total knee arthroplasty. Knee Surgery, Sports Traumatol Arthrosc 2011; 19 (12) 2040-2044
• 17 Ge DH, Anoushiravani AA, Kester BS, Vigdorchik JM, Schwarzkopf R. Preoperative diagnosis can predict conversion total knee arthroplasty outcomes. J Arthroplasty 2018; 33 (01) 124-129.e1
• 18 Tarazi JM, Chen Z, Scuderi GR, Mont MA. The epidemiology of revision total knee arthroplasty. J Knee Surg 2021; 34 (13) 1396-1401
• 19 Lunebourg A, Parratte S, Gay A, Ollivier M, Garcia-Parra K, Argenson JN. Lower function, quality of life, and survival rate after total knee arthroplasty for posttraumatic arthritis than for primary arthritis. Acta Orthop 2015; 86 (02) 189-194
• 20 Kester BS, Minhas SV, Vigdorchik JM, Schwarzkopf R. Total knee arthroplasty for posttraumatic osteoarthritis: is it time for a new classification?. J Arthroplasty 2016; 31 (08) 1649-1653.e1
• 21 McCulloch R, Cottingham P, Chrismas B, Pearce O. Is it time we changed how we measure length of stay for hip and knee arthroplasty?. J Am Acad Orthop Surg Glob Res Rev. 2017; 1 (06) e032
• 22 Gu A, Malahias MA, Cohen JS. et al. Prior knee arthroscopy is associated with increased risk of revision after total knee arthroplasty. J Arthroplasty 2020; 35 (01) 100-104
• 23 Barton SB, McLauchlan GJ, Canty SJ. The incidence and impact of arthroscopy in the year prior to total knee arthroplasty. Knee 2017; 24 (02) 396-401
• 24 Parratte S, Lunebourg A, Ollivier M, Abdel MP, Argenson JNA. Are revisions of patellofemoral arthroplasties more like primary or revision TKAs. Clin Orthop Relat Res 2015; 473 (01) 213-219
• 25 Manzotti A, Pullen C, Cerveri P, Chemello C, Confalonieri N. Post traumatic knee arthritis: navigated total knee replacement without hardware removal. Knee 2014; 21 (01) 290-294
• 26 Meding JB, Wing JT, Ritter MA. Does high tibial osteotomy affect the success or survival of a total knee replacement?. Clin Orthop Relat Res 2011; 469 (07) 1991-1994