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TotalHipandKneeReplacement
Modes of Failure in Revision Hip and Knee Replacement Kevin J. Bozic, MD, MBA Harry E. Rubash, MD J. Berry, MD Khaled J. Saleh, MD, MPH Sridhar M. Durbhakula, MD “It’s like déjà vu all over again!” Background Total joint replacement is one of the most commonly performed and successful operations in orthopaedics as defined by clinical outcomes and implant survivorship* * Background Total joint replacement (TJR) is one of the most cost-effective procedures in all of medicine. TJA Volume Estimates U.S. TJR Payer Mix DRG 209/471: 1998-2002 TJR Failure Despite the success achieved with most primary TJR procedures, factors related to implant longevity and a younger, more active patient population have led to a steady increase in the number of failed TJR’s Problem with Current ICD-9-CM Diagnosis Codes Currently, all failed TJR’s are coded as either: 996.4 Mechanical complication of an internal orthopedic device, implant, or graft: Mechanical complications involving external fixation device using internal screw(s), pin(s), or other methods of fixation; grafts of bone, cartilage, muscle, or tendon; internal fixation device such as nail, plate, rod, etc. 996.6 Infection and inflammatory reaction due to internal joint prosthesis Problem with Current ICD-9-CM Diagnosis Codes New technologies and surgical techniques are constantly being introduced into the marketplace Despite careful laboratory testing, a certain percentage of new technologies are associated with higher rates of clinical failure Current ICD-9-CM Diagnosis codes limit our ability to track clinical outcomes and complications related to new techniques and technologies in TJR TJA: Indications Arthritis—Background Arthritis is the second most common chronic condition in the US (sinusitis is first) Most common among elderly 20-30% of people over age 70 suffer from osteoarthritis (OA) of the hip Arthritis affects over 32 million people in the US Total costs associated with arthritis are over $82B/year, i
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