The Economic Impact of Lower Extremity Peri-Prosthetic Fractures in a Large Hospital System.

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The Journal of arthroplasty


washington; system; portland; oregon; california; santa rosa; sjh


INTRODUCTION: Peri-prosthetic fractures place a burden on hospital systems. They occur in older patients with medical comorbidities, as unplanned events requiring technically complex surgeries with expensive implants. The purpose of this study was to describe this patient population and evaluate the economic impact of peri-prosthetic fractures on a hospital system.

METHODS: We conducted a retrospective study of peri-prosthetic fractures of the hip and knee between 2018 and 2019. Demographics, length of stay (LOS), and discharge disposition were collected. We performed chart and radiographic reviews to determine fracture classification and type of treatment performed. Analysis of direct inpatient costs was performed and categorized by fracture type.

RESULTS: We identified 213 peri-prosthetic hip and 151 peri-prosthetic knee fractures. Mean age of hip patients was 77, and 71% were female. Average surgery time was 194 minutes, LOS was 5.01 days, and 71% were discharged to a skilled nursing facility (SNF). Mean age of knee patients was 76, and 79% were female. The average surgery time was 174 minutes, LOS was 5.12 days, and 70% were discharged to a SNF. Median direct cost of hip fractures was $17,108, with Vancouver B2 and B3 costing significantly more at $19,987 and $23,935 respectively (p-value

CONCLUSION: Peri-prosthetic fractures create a significant economic impact on hospital systems. We stratified the costs of treatment based on fracture type. Significantly higher costs are associated with injuries requiring revision implants.

Clinical Institute

Orthopedics & Sports Medicine