Cost Analysis of Revision Total Hip Arthroplasty: Influencing Factors and Etiological Impact

Cost Analysis of Revision Total Hip Arthroplasty: Influencing Factors and Etiological Impact | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cost Analysis of Revision Total Hip Arthroplasty: Influencing Factors and Etiological Impact Orhun Eray Bozkurt, Hakan Kocaoglu, Kerem Basarir, Bulent Abdurrahman Erdemli, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6691854/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Total hip arthroplasty (THA) is widely recognized as a landmark surgical procedure of the 20th century, frequently performed due to its favorable outcomes. However, revision hip arthroplasty is more complex, associated with higher complication rates and increased healthcare costs compared to primary procedures. Objective This study aims to analyze the costs associated with revision hip arthroplasty, identify factors influencing these costs, and evaluate the impact of revision etiologies on financial burden. Additionally, it seeks to raise awareness about improving the longevity of primary THA and contribute to the development of a national joint registry. Methods A retrospective analysis was conducted on patients undergoing revision (n = 205) and primary (n = 737) total hip arthroplasty at a single center between 2017–2022. Data including demographics, comorbidities, hospital length of stay, surgical details, complications, and cost information were extracted from hospital records. Statistical analyses were performed to assess differences in cost and clinical variables between groups. Results The median cost for revision THA was significantly higher than for primary THA (15,069.77 TL vs. 8,716.47 TL, p < 0.001). Increased comorbidity burden was associated with higher costs in both groups (p < 0.001). The most common revision indications were aseptic loosening, infection, and periprosthetic fractures, with septic and fracture-related revisions incurring significantly greater costs than aseptic cases. Two-stage revision surgeries were more costly than single-stage procedures (p < 0.001). Additionally, revision cases had longer median hospital stays compared to primary cases (11.5 vs. 3 days, p < 0.001). Conclusions Revision hip arthroplasty imposes substantially greater financial burden than primary procedures, influenced by complications, surgical approach, and revision etiology. Preventive strategies targeting infection reduction and complication minimization are crucial to control escalating costs. With an aging population, the demand for both primary and revision THA is expected to rise, underscoring the need for effective health system planning and cost management strategies. Total Hip Arthroplasty Revision Hip Arthroplasty Cost Analysis Etiology of Revision Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Total hip arthroplasty (THA) has been described as the 'surgery of the century,' considering advancements in the implantation of artificial hip joints in the 20th century. THA is one of the most frequently performed orthopedic surgeries due to its favorable postoperative outcomes [ 1 ]. Consequently, cost analysis of these surgeries has been the subject of many studies [ 2 – 4 ]. With increasing life expectancy and population growth, the number of THAs is rising. Correspondingly, the number of revision hip arthroplasties is also expected to increase [ 5 – 7 ]. Revision surgery is more complex than primary joint replacement and is associated with poorer prognosis and higher failure risk. The presence of bone and soft tissue defects makes the surgery technically challenging and leads to higher complication rates compared to primary replacement [ 8 – 10 ]. Utilization of hospital resources and the cost of revision surgery are significantly higher than those of primary replacement [ 11 ]. Revision surgeries take longer to perform, involve more expensive prostheses, and extend the patient’s hospital stay, resulting in increased costs [ 11 ]. According to the 2010 report of the United Kingdom National Joint Registry, 76,759 hip replacement surgeries were performed, of which 7,852 (10.2%) were reported as revision surgeries. In the same study, the most common reasons for revision surgery were aseptic loosening (45%), pain (26%), dislocation (15%), osteolysis (14%), and infection [ 5 ]. According to a study conducted in the United States, the prevalence of total hip arthroplasty in adults aged 50 years and older was estimated to be 2.34% in 2010. Despite the success of total hip arthroplasty as a surgical procedure, the growing population and various reasons for failure pose a significant burden on the healthcare system [ 12 ]. The aim of this study is to analyze the costs of revision hip arthroplasty, identify the factors influencing these costs, and evaluate the impact of revision causes on costs. Additionally, this study aims to raise awareness about improving the survival of primary total hip arthroplasty. We hope this study will contribute to increased awareness on this subject and aid in the development of a national joint registry system. Material and methods Using our hospital’s software program, patients who were coded under the Social Security Institution (SGK) surgery codes P612480 (hip revision arthroplasty, total), P612470 (hip arthroplasty, acetabular liner replacement, total), P612471 (acetabular revision of the hip, partial), P612472 (femoral stem revision of the hip, partial), and P12340 (hip joint total prosthesis) between January 2017–2022 were identified. Approval for the study was granted by the Ethics Committees of the institution (İ07-490-23). Informed consent was obtained from all individual participants included in the study. A total of 205 patients who underwent revision total hip arthroplasty and 737 patients who underwent primary total hip arthroplasty during this period were included in the study. The inclusion and exclusion criteria of the study are shown in the flowchart (Fig. 1 ). Cost documentation for revision and primary total hip arthroplasty operations was obtained from the billing department of our hospital’s information management system. Based on information obtained from the hospital’s software program and patient files, demographic data (age, gender, laterality), comorbidities (diabetes, hypertension, chronic obstructive pulmonary disease, coronary artery disease, chronic kidney disease, other diseases), the number of surgical procedures undergone, hospital length of stay, and materials used during surgery were collected for the patients. Statistical Analysis Descriptive statistics were presented as median (minimum, maximum, IQR) and frequency (percentage). The normality assumption of quantitative data was tested using the Kolmogorov-Smirnov Test. For the analysis of quantitative data, Student's T-Test or Mann-Whitney U Test was used depending on the normality assumption, while Pearson’s Chi-Square or Fisher’s Exact Test was applied for the evaluation of categorical data. The relationship between quantitative variables was assessed using the Spearman's Rho Correlation Coefficient. A p-value of < 0.05 was considered statistically significant, and the analyses were performed using the Statistical Package for Social Sciences (SPSS, Version 15.0, Chicago, IL). Results The demographic data of the 205 revision and 737 primary hip arthroplasty patients included in the study are shown in Table 1 . The comorbidities of the patients were also evaluated, and it was observed that as comorbidities increased, the cost statistically significantly increased for both primary hip arthroplasty (p < 0.001) and revision hip arthroplasty (p < 0.001). The distribution of operated patients by year is shown in Fig. 2 . In all years, the number of primary hip arthroplasty patients was higher. When comparing the total costs of primary and revision hip arthroplasty cases over the six years, the median cost for revision cases was 15,069.77 Turkish Lira (TL), while for primary hip arthroplasties, it was 8,716.47 TL. This difference was statistically significant (p < 0.001). When evaluated by year, the costs for revision cases were found to be higher in every year (2017: p = 0.335, 2018: p < 0.001, 2019: p < 0.001, 2020: p < 0.001, 2021: p = 0.238, 2022: p < 0.001) (Fig. 3 ). Complications were significantly higher in hip arthroplasty cases (p < 0.001) (Table 2, Fig. 4 ). In both groups, the cost per patient increased significantly as complications increased (p < 0.001 for both). Among primary hip arthroplasty patients without complications, the median cost per patient was 8,672.55 TL, while it was 15,725.34 TL for those with complications. In revision cases, the median cost was 13,799.19 TL for those without complications and 29,354.14 TL for those with complications. The etiology for revision total hip arthroplasty are shown in Fig. 5 . When examining the etiologies individually, infection emerges as the most common cause. When categorized into three subgroups—septic, aseptic, and periprosthetic fractures—aseptic causes (113 patients, 55%) are identified as the most frequent. Septic causes (63 patients, 31%) rank second, followed by periprosthetic fractures (29 patients, 14%) in third place. When examining the relationship between etiologies and costs, a statistically significant difference was found between septic and aseptic causes (p < 0.001) and between periprosthetic fractures and aseptic causes (p = 0.02) (Table 3 ). The average follow-up time in months between primary and revision surgeries is also shown in Table 3 . The time to revision surgery due to periprosthetic fractures was significantly shorter compared to surgeries performed for septic or aseptic reasons (p = 0.012, p = 0.02). The etiologies in patients who underwent primary hip arthroplasty are shown in Fig. 6 . The most common cause was primary coxarthrosis (488 patients, 66%). This was followed by congenital hip dislocation in 74 patients (10%) and osteonecrosis in 70 patients (10%). Femoral neck fracture ranked next, with 60 patients (8%). Regarding hospital length of stay, the median duration for revision cases was 11.5 days, while for primary hip arthroplasty, it was 3 days (p < 0.001). The distribution of etiologies by age and age-based characteristics for revision cases are presented in Table 4 . Among the revision cases, 130 patients (63.4%) had their initial operation in our clinic, while 75 patients (36.6%) had their initial operation at an external center. The median cost was 15,051.77 TL for patients whose initial surgery was performed in our clinic and 16,446.18 TL for those operated on elsewhere, with no statistically significant difference (p = 0.793). The cost per patient also varied depending on the type and number of components changed during revision hip arthroplasty. Total implant replacement, performed in 114 patients (55.6%), was the most frequent, and the median cost per patient was highest in this group, which was statistically significant (p < 0.001) (Table 5 ). Of the 205 revision hip arthroplasty cases, 160 underwent single-stage surgery, while 45 underwent two-stage surgery. The cost was significantly higher for two-stage surgeries (13,636.31 TL vs. 27,968.35 TL) (p < 0.001). Discussion Primary and revision hip arthroplasty cost analyses and their annual variations were comprehensively assessed in this study. The secondary aim was to analyze costs based on the etiologies of revision hip arthroplasties and to establish epidemiological data. In a study conducted by Weber et al. [ 13 ], primary knee and hip arthroplasty costs were compared with those of revision knee and hip arthroplasties. They found that revision surgeries had an average hospital stay four days longer than primary surgeries. Moreover, the cost of revision surgeries was significantly higher, with revision cases costing $ 7110.8 ± 2249.4 compared to $ 4041.1 ± 975.7 for primary cases. Previous studies have shown that revision surgeries due to periprosthetic hip fractures can impose a financial burden similar to infected cases [ 14 , 15 ]. Our study yielded similar findings, indicating that costs associated with aseptic cases were lower compared to revisions performed due to septic or periprosthetic fracture-related causes. The higher costs in septic revision surgeries were attributed to longer hospital stays, the necessity of two-stage procedures, extended antibiotic therapy, and the use of additional implants for osteosynthesis and fixation in periprosthetic fracture-related revisions compared to aseptic cases. In a study by Phillips et al. [ 16 ], 80% of the costs in periprosthetic hip fracture cases were found to be attributable to inpatient care. Another study by Jones et al. [ 17 ] emphasized that appropriate rehabilitation following periprosthetic fractures could help reduce costs. Our analysis of yearly cost trends revealed a significant increase in the per-patient cost of both primary and revision hip arthroplasties in 2022. We attribute this to the sharp increase in the USD/TRY exchange rate during this period and the impact of the COVID-19 pandemic, which began in Turkey on March 11, 2020. The reduction in elective surgeries and pandemic-related conditions may have also influenced our findings. Kelmer et al. [ 18 ] reported that early revisions within the first two years were predominantly due to septic causes and periprosthetic fractures. In our study, periprosthetic fractures were observed significantly earlier than other causes in revision cases. The mean time to septic revision after primary hip arthroplasty was 117.5 ± 12.04 months. Preventing complications in hip arthroplasty surgery requires attention to critical points during the preoperative, intraoperative, and postoperative phases. In addition to surgical planning and intraoperative protocols, educating patients during the postoperative period is essential for minimizing potential complications. A study by Demir et al. [ 19 ] showed that while adherence to recommendations was high in the early postoperative period, compliance decreased over time. Our study detailed and explained factors influencing costs in hip arthroplasty, underscoring the importance of preventive measures to reduce expenses. Preventive approaches may include patient-specific surgical planning, strict adherence to sterilization and surgical protocols, improved postoperative care, and adopting a multidisciplinary approach for high-risk patients. Preventive strategies could also involve early diagnosis and treatment of conditions like osteoporosis, modifying home and living environments to prevent falls, and promoting physical activity and proper nutrition to support bone and muscle health. This study makes a significant contribution by analyzing a large patient population from 2017 to 2022, presenting detailed demographic and clinical data, and comprehensively comparing revision and primary hip arthroplasty procedures. By revealing the cost impacts of complications and etiologies, it provides valuable information to the literature. The use of robust statistical methods and consideration of local economic conditions within the national healthcare system enhance the reliability and practical relevance of the results. However, the study also has limitations. Being a single-center study without multi-center data and the retrospective design leading to potentially missing or limited data could affect the certainty of the findings. Conclusion This study provides a detailed analysis of the costs associated with primary and revision hip arthroplasties. It demonstrates that revision hip arthroplasty is associated with significantly higher costs compared to primary cases, and this difference is attributed to various factors such as complications, etiological causes, and surgical methods. The study highlights the need for healthcare systems to develop effective prevention and management strategies in the face of rising costs. Particularly, measures aimed at reducing infection rates and improving postoperative rehabilitation processes to prevent periprosthetic fractures could play a critical role in cost reduction. Our study also emphasizes that with the aging population, the number of both primary and revision surgeries is expected to increase, underscoring the importance of healthcare systems being prepared for this trend. Prospective studies with larger sample sizes will enhance the generalizability of these findings and contribute to the development of cost-effective strategies. Declarations Author Contribution All authors contributed to the study conception and design. All authors commented on previous versions of the manuscript. All authors reviewed the manuscript.O.E.B: Wrote the main manuscript, conceived and design the analysis, final approval of the version to be published, collected the data, collected the data, wrote the paper, prepared the figures and tables, M.B.G: Wrote the main manuscript, collected the data, collected the data, wrote the paper, prepared the figures and tables, H.K.: Performed the analysis, contributed data or analysis tools, K.B: Performed the analysis, contributed data or analysis tools, B.A.E: Performed the analysis, collected the data, E.D: Performed the analysis and statistics, prepared the figures and tables References Anderson PM et al (2022) Total hip arthroplasty in geriatric patients - a single-center experience. SICOT J 8:12 Agarwal N, To K, Khan W (2021) Cost effectiveness analyses of total hip arthroplasty for hip osteoarthritis: A PRISMA systematic review. Int J Clin Pract 75(2):e13806 Chin G et al (2016) Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis. J Arthroplasty 31(2):362–367 Lavernia CJ et al (2015) The Cost-Utility of Total Hip Arthroplasty: Earlier Intervention, Improved Economics. J Arthroplasty 30(6):945–949 Vanhegan IS et al (2012) A financial analysis of revision hip arthroplasty: the economic burden in relation to the national tariff. J Bone Joint Surg Br 94(5):619–623 Kurtz S et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785 Yenigul AE et al (2023) Comparison of patients undergoing revision total hip arthroplasty and patients undergoing re-revision. Eur Rev Med Pharmacol Sci 27(11):5053–5058 Sheth NP et al (2013) Acetabular bone loss in revision total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg 21(3):128–139 Lie SA et al (2004) Failure rates for 4762 revision total hip arthroplasties in the Norwegian Arthroplasty Register. J Bone Joint Surg Br 86(4):504–509 Clohisy JC et al Reasons for revision hip surgery: a retrospective review. Clin Orthop Relat Res, 2004(429): p. 188–192 Bozic KJ et al (2005) Hospital resource utilization for primary and revision total hip arthroplasty. J Bone Joint Surg Am 87(3):570–576 Maradit Kremers H et al (2015) Prevalence of Total Hip and Knee Replacement in the United States. J Bone Joint Surg Am 97(17):1386–1397 Weber M et al (2018) Revision Surgery in Total Joint Replacement Is Cost-Intensive. Biomed Res Int, 2018: p. 8987104 Bozic KJ, Ries MD (2005) The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am 87(8):1746–1751 Lindahl H et al (2005) Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty 20(7):857–865 Phillips JR, Morac BC, Manktelov CG (2011) What is the financial cost of treating periprosthetic hip fractures? Injury 42(2):146–149 Jones AR et al (2016) The economic impact of surgically treated peri-prosthetic hip fractures on a university teaching hospital in Wales 7.5-year study. Injury 47(2):428–431 Kelmer G et al (2021) Reasons for Revision: Primary Total Hip Arthroplasty Mechanisms of Failure. J Am Acad Orthop Surg 29(2):78–87 Demir B, Rakkad AN, Ayasgil N, Çatal M, Azboy B (2024) Are Recommendations Followed after Total Hip Arthroplasty? A Questionnaire. Istanbul Med J 25(1):31–35 Tables Table 1 : Distribution of patients' demographic data Primary total hip arthroplasty Revision total hip arthroplasty Number of patients 737 (78.2%) 205 (21.8%) Age 60.70 ± 13.97 65.8 ± 14.21 Gender (Male/Female) 74 (7.9%)/ 131 (13.9%) 227 (24.1%)/ 510 (54.1%) Side (Right/Left) 337 (35.8%)/ 400 (42.5%) 100 (10.6%)/ 105 (11.1%) Tablo 2: Comparison of complication rates in primary and revision hip arthroplasty Complication Total Presence Absence Primary Hip Arthroplasty 44(6%) 693(94%) 737(100%) Revision Hip Arthroplasty 43(21%) 162(79%) 205(100%) Table 3: Comparison of cost and follow-up time in revision patients Number of patients Follow-up (month) Cost (TL) Septic 63 (31%) 117,5±12.04 23016,21 Aseptic 113 (55% ) 125,1±9.05 12139,7 Periprosthetic fracture 29 (14%) 62.3±15.3 17975,9 Table 4 : Etiological distribution of revision cases according to age groups Septic Aseptic Periprosthetic Fracture Total Yaş ≤40 4 (36.4%) 7 (63.6%) 0 (0%) 11 (100%) 41-50 6 (42.9%) 5 (35.7%) 3 (21.4%) 14 (100%) 51-60 21 (37.5%) 35 (62.5%) 0 (0%) 56 (100%) 61-70 14 (40%) 10 (28.6%) 11 (31.4%) 35 (100%) 71-80 18 (30%) 31 (53%) 10 (17%) 59 (100%) ≥81 0 (0%) 25 (83.3%) 5 (16.7%) 30 (100%) Toplam 63 (31%) 113 (55%) 29 (14%) 205 (100%) Table 5: Type of component changed in revision cases and cost analysis Number of patient Cost (TL) Total 114 (%55.6) 18528 Acetabulum 51 (%24.9) 9869,59 Femur 25 (%12.2) 13938,8 Liner 15 (%7.3) 6822,74 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6691854","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":465485522,"identity":"7908d461-6260-4e03-8d49-a37620b4768d","order_by":0,"name":"Orhun Eray Bozkurt","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYBACAwYGNiiTsfFBwg8bMOMAkVqYmw0+9qSBtDQQq4W9TXIG22EwE68Wc/beZ495d9jk889IbDbm4Tlvt7b9MNCWGptoXFose46bG/OeSbOccSOx8TGPxe3kbWcSgVqOpeU24HLYjTQ2ad62wwYMN8C23E42OwDUwthwmJCW/wbyNxLbpHnYziWbnX9IlJYDBgZALUDvH7Azu0HAFsueY2ySc9uSDQzPPAQFcnKC2Q2gLQl4/GLO3sYm8bbNzkDuePpDYFTa2ZudBzI+1Njg1IIAAglgKhGsMoGgchDgPwCm7IlSPApGwSgYBSMKAAAGOGSphbHsTwAAAABJRU5ErkJggg==","orcid":"","institution":"Kulu State Hospital","correspondingAuthor":true,"prefix":"","firstName":"Orhun","middleName":"Eray","lastName":"Bozkurt","suffix":""},{"id":465485523,"identity":"a14f3676-b393-4def-98f4-8429622fe233","order_by":1,"name":"Hakan Kocaoglu","email":"","orcid":"","institution":"Ankara University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Hakan","middleName":"","lastName":"Kocaoglu","suffix":""},{"id":465485524,"identity":"a42e1133-cfa9-432d-a282-134de235e8f7","order_by":2,"name":"Kerem Basarir","email":"","orcid":"","institution":"Private Practice","correspondingAuthor":false,"prefix":"","firstName":"Kerem","middleName":"","lastName":"Basarir","suffix":""},{"id":465485525,"identity":"8add1197-c42a-46dc-9e68-02196732ae80","order_by":3,"name":"Bulent Abdurrahman Erdemli","email":"","orcid":"","institution":"Ankara University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Bulent","middleName":"Abdurrahman","lastName":"Erdemli","suffix":""},{"id":465485526,"identity":"b937667a-08cb-4709-a994-03a3885e11ad","order_by":4,"name":"Ebru Dumlupinar","email":"","orcid":"","institution":"Ankara University","correspondingAuthor":false,"prefix":"","firstName":"Ebru","middleName":"","lastName":"Dumlupinar","suffix":""},{"id":465485527,"identity":"26439fc0-23f0-4ced-8b06-7dabf2fa7d5f","order_by":5,"name":"Mehmet Bahaddin Guzel","email":"","orcid":"","institution":"Ankara University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"Bahaddin","lastName":"Guzel","suffix":""}],"badges":[],"createdAt":"2025-05-18 13:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6691854/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6691854/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83902538,"identity":"e2cf5c60-d5c6-4cbf-bfda-0fd2341c7478","added_by":"auto","created_at":"2025-06-04 09:43:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":17004,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6691854/v1/acefb846ce17dd897f6a172c.png"},{"id":83902536,"identity":"51517b57-c867-4ab4-965f-e9e716622af8","added_by":"auto","created_at":"2025-06-04 09:43:53","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":16025,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of operated patients by year\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6691854/v1/faceed68aec83d8875c36c4e.png"},{"id":83903160,"identity":"b9062c2b-1c22-4e68-ab72-2a235fe832e1","added_by":"auto","created_at":"2025-06-04 09:51:54","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":44337,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of cost analysis of primary and revision hip arthroplasty cases by year\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6691854/v1/a54ac4781a86957b2b78979c.png"},{"id":83903168,"identity":"bdfd7f7c-287c-4207-b9e1-157d1bd660c8","added_by":"auto","created_at":"2025-06-04 09:51:54","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":26663,"visible":true,"origin":"","legend":"\u003cp\u003eComplication types in primary and revision hip prostheses\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6691854/v1/365e43fa1a93bf1a8e037575.png"},{"id":83904665,"identity":"92bc2dc0-dfb4-498b-b492-781873beb8ae","added_by":"auto","created_at":"2025-06-04 10:07:54","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":25091,"visible":true,"origin":"","legend":"\u003cp\u003eEtiology of Revision Total Hip Arthroplasty\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6691854/v1/fdefb1cb75a58363b1bdc0f8.png"},{"id":83902546,"identity":"a3c73ade-4431-477d-bf2b-dfd6772a5ba5","added_by":"auto","created_at":"2025-06-04 09:43:54","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":69580,"visible":true,"origin":"","legend":"\u003cp\u003eEtiology for primary hip arthroplasty\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-6691854/v1/64c4fc24c2574f24338fb412.png"},{"id":97140022,"identity":"fafcbfd1-6fdc-4e92-b96a-f29804cf78d2","added_by":"auto","created_at":"2025-12-01 10:03:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":771988,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6691854/v1/a41f24bd-dd20-4f98-adb3-f8801c5adfd8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cost Analysis of Revision Total Hip Arthroplasty: Influencing Factors and Etiological Impact","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTotal hip arthroplasty (THA) has been described as the 'surgery of the century,' considering advancements in the implantation of artificial hip joints in the 20th century. THA is one of the most frequently performed orthopedic surgeries due to its favorable postoperative outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Consequently, cost analysis of these surgeries has been the subject of many studies [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. With increasing life expectancy and population growth, the number of THAs is rising. Correspondingly, the number of revision hip arthroplasties is also expected to increase [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Revision surgery is more complex than primary joint replacement and is associated with poorer prognosis and higher failure risk. The presence of bone and soft tissue defects makes the surgery technically challenging and leads to higher complication rates compared to primary replacement [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Utilization of hospital resources and the cost of revision surgery are significantly higher than those of primary replacement [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Revision surgeries take longer to perform, involve more expensive prostheses, and extend the patient\u0026rsquo;s hospital stay, resulting in increased costs [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. According to the 2010 report of the United Kingdom National Joint Registry, 76,759 hip replacement surgeries were performed, of which 7,852 (10.2%) were reported as revision surgeries. In the same study, the most common reasons for revision surgery were aseptic loosening (45%), pain (26%), dislocation (15%), osteolysis (14%), and infection [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. According to a study conducted in the United States, the prevalence of total hip arthroplasty in adults aged 50 years and older was estimated to be 2.34% in 2010. Despite the success of total hip arthroplasty as a surgical procedure, the growing population and various reasons for failure pose a significant burden on the healthcare system [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The aim of this study is to analyze the costs of revision hip arthroplasty, identify the factors influencing these costs, and evaluate the impact of revision causes on costs. Additionally, this study aims to raise awareness about improving the survival of primary total hip arthroplasty. We hope this study will contribute to increased awareness on this subject and aid in the development of a national joint registry system.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eUsing our hospital\u0026rsquo;s software program, patients who were coded under the Social Security Institution (SGK) surgery codes P612480 (hip revision arthroplasty, total), P612470 (hip arthroplasty, acetabular liner replacement, total), P612471 (acetabular revision of the hip, partial), P612472 (femoral stem revision of the hip, partial), and P12340 (hip joint total prosthesis) between January 2017\u0026ndash;2022 were identified. Approval for the study was granted by the Ethics Committees of the institution (İ07-490-23). Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e \u003cp\u003eA total of 205 patients who underwent revision total hip arthroplasty and 737 patients who underwent primary total hip arthroplasty during this period were included in the study. The inclusion and exclusion criteria of the study are shown in the flowchart (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Cost documentation for revision and primary total hip arthroplasty operations was obtained from the billing department of our hospital\u0026rsquo;s information management system. Based on information obtained from the hospital\u0026rsquo;s software program and patient files, demographic data (age, gender, laterality), comorbidities (diabetes, hypertension, chronic obstructive pulmonary disease, coronary artery disease, chronic kidney disease, other diseases), the number of surgical procedures undergone, hospital length of stay, and materials used during surgery were collected for the patients.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were presented as median (minimum, maximum, IQR) and frequency (percentage). The normality assumption of quantitative data was tested using the Kolmogorov-Smirnov Test. For the analysis of quantitative data, Student's T-Test or Mann-Whitney U Test was used depending on the normality assumption, while Pearson\u0026rsquo;s Chi-Square or Fisher\u0026rsquo;s Exact Test was applied for the evaluation of categorical data. The relationship between quantitative variables was assessed using the Spearman's Rho Correlation Coefficient. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant, and the analyses were performed using the Statistical Package for Social Sciences (SPSS, Version 15.0, Chicago, IL).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe demographic data of the 205 revision and 737 primary hip arthroplasty patients included in the study are shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The comorbidities of the patients were also evaluated, and it was observed that as comorbidities increased, the cost statistically significantly increased for both primary hip arthroplasty (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and revision hip arthroplasty (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The distribution of operated patients by year is shown in Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. In all years, the number of primary hip arthroplasty patients was higher.\u003c/p\u003e\n\u003cp\u003eWhen comparing the total costs of primary and revision hip arthroplasty cases over the six years, the median cost for revision cases was 15,069.77 Turkish Lira (TL), while for primary hip arthroplasties, it was 8,716.47 TL. This difference was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). When evaluated by year, the costs for revision cases were found to be higher in every year (2017: p\u0026thinsp;=\u0026thinsp;0.335, 2018: p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 2019: p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 2020: p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 2021: p\u0026thinsp;=\u0026thinsp;0.238, 2022: p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eComplications were significantly higher in hip arthroplasty cases (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table 2, Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). In both groups, the cost per patient increased significantly as complications increased (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for both). Among primary hip arthroplasty patients without complications, the median cost per patient was 8,672.55 TL, while it was 15,725.34 TL for those with complications. In revision cases, the median cost was 13,799.19 TL for those without complications and 29,354.14 TL for those with complications.\u003c/p\u003e\n\u003cp\u003eThe etiology for revision total hip arthroplasty are shown in Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e. When examining the etiologies individually, infection emerges as the most common cause. When categorized into three subgroups\u0026mdash;septic, aseptic, and periprosthetic fractures\u0026mdash;aseptic causes (113 patients, 55%) are identified as the most frequent. Septic causes (63 patients, 31%) rank second, followed by periprosthetic fractures (29 patients, 14%) in third place.\u003c/p\u003e\n\u003cp\u003eWhen examining the relationship between etiologies and costs, a statistically significant difference was found between septic and aseptic causes (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and between periprosthetic fractures and aseptic causes (p\u0026thinsp;=\u0026thinsp;0.02) (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). The average follow-up time in months between primary and revision surgeries is also shown in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. The time to revision surgery due to periprosthetic fractures was significantly shorter compared to surgeries performed for septic or aseptic reasons (p\u0026thinsp;=\u0026thinsp;0.012, p\u0026thinsp;=\u0026thinsp;0.02).\u003c/p\u003e\n\u003cp\u003eThe etiologies in patients who underwent primary hip arthroplasty are shown in Fig. \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e. The most common cause was primary coxarthrosis (488 patients, 66%). This was followed by congenital hip dislocation in 74 patients (10%) and osteonecrosis in 70 patients (10%). Femoral neck fracture ranked next, with 60 patients (8%).\u003c/p\u003e\n\u003cp\u003eRegarding hospital length of stay, the median duration for revision cases was 11.5 days, while for primary hip arthroplasty, it was 3 days (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The distribution of etiologies by age and age-based characteristics for revision cases are presented in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eAmong the revision cases, 130 patients (63.4%) had their initial operation in our clinic, while 75 patients (36.6%) had their initial operation at an external center. The median cost was 15,051.77 TL for patients whose initial surgery was performed in our clinic and 16,446.18 TL for those operated on elsewhere, with no statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.793).\u003c/p\u003e\n\u003cp\u003eThe cost per patient also varied depending on the type and number of components changed during revision hip arthroplasty. Total implant replacement, performed in 114 patients (55.6%), was the most frequent, and the median cost per patient was highest in this group, which was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eOf the 205 revision hip arthroplasty cases, 160 underwent single-stage surgery, while 45 underwent two-stage surgery. The cost was significantly higher for two-stage surgeries (13,636.31 TL vs. 27,968.35 TL) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrimary and revision hip arthroplasty cost analyses and their annual variations were comprehensively assessed in this study. The secondary aim was to analyze costs based on the etiologies of revision hip arthroplasties and to establish epidemiological data.\u003c/p\u003e \u003cp\u003eIn a study conducted by Weber et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], primary knee and hip arthroplasty costs were compared with those of revision knee and hip arthroplasties. They found that revision surgeries had an average hospital stay four days longer than primary surgeries. Moreover, the cost of revision surgeries was significantly higher, with revision cases costing \u003cspan\u003e$\u003c/span\u003e7110.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2249.4 compared to \u003cspan\u003e$\u003c/span\u003e4041.1\u0026thinsp;\u0026plusmn;\u0026thinsp;975.7 for primary cases.\u003c/p\u003e \u003cp\u003ePrevious studies have shown that revision surgeries due to periprosthetic hip fractures can impose a financial burden similar to infected cases [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Our study yielded similar findings, indicating that costs associated with aseptic cases were lower compared to revisions performed due to septic or periprosthetic fracture-related causes. The higher costs in septic revision surgeries were attributed to longer hospital stays, the necessity of two-stage procedures, extended antibiotic therapy, and the use of additional implants for osteosynthesis and fixation in periprosthetic fracture-related revisions compared to aseptic cases.\u003c/p\u003e \u003cp\u003eIn a study by Phillips et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], 80% of the costs in periprosthetic hip fracture cases were found to be attributable to inpatient care. Another study by Jones et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] emphasized that appropriate rehabilitation following periprosthetic fractures could help reduce costs.\u003c/p\u003e \u003cp\u003eOur analysis of yearly cost trends revealed a significant increase in the per-patient cost of both primary and revision hip arthroplasties in 2022. We attribute this to the sharp increase in the USD/TRY exchange rate during this period and the impact of the COVID-19 pandemic, which began in Turkey on March 11, 2020. The reduction in elective surgeries and pandemic-related conditions may have also influenced our findings.\u003c/p\u003e \u003cp\u003eKelmer et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] reported that early revisions within the first two years were predominantly due to septic causes and periprosthetic fractures. In our study, periprosthetic fractures were observed significantly earlier than other causes in revision cases. The mean time to septic revision after primary hip arthroplasty was 117.5\u0026thinsp;\u0026plusmn;\u0026thinsp;12.04 months.\u003c/p\u003e \u003cp\u003ePreventing complications in hip arthroplasty surgery requires attention to critical points during the preoperative, intraoperative, and postoperative phases. In addition to surgical planning and intraoperative protocols, educating patients during the postoperative period is essential for minimizing potential complications. A study by Demir et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] showed that while adherence to recommendations was high in the early postoperative period, compliance decreased over time.\u003c/p\u003e \u003cp\u003eOur study detailed and explained factors influencing costs in hip arthroplasty, underscoring the importance of preventive measures to reduce expenses. Preventive approaches may include patient-specific surgical planning, strict adherence to sterilization and surgical protocols, improved postoperative care, and adopting a multidisciplinary approach for high-risk patients. Preventive strategies could also involve early diagnosis and treatment of conditions like osteoporosis, modifying home and living environments to prevent falls, and promoting physical activity and proper nutrition to support bone and muscle health.\u003c/p\u003e \u003cp\u003eThis study makes a significant contribution by analyzing a large patient population from 2017 to 2022, presenting detailed demographic and clinical data, and comprehensively comparing revision and primary hip arthroplasty procedures. By revealing the cost impacts of complications and etiologies, it provides valuable information to the literature. The use of robust statistical methods and consideration of local economic conditions within the national healthcare system enhance the reliability and practical relevance of the results. However, the study also has limitations. Being a single-center study without multi-center data and the retrospective design leading to potentially missing or limited data could affect the certainty of the findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides a detailed analysis of the costs associated with primary and revision hip arthroplasties. It demonstrates that revision hip arthroplasty is associated with significantly higher costs compared to primary cases, and this difference is attributed to various factors such as complications, etiological causes, and surgical methods. The study highlights the need for healthcare systems to develop effective prevention and management strategies in the face of rising costs. Particularly, measures aimed at reducing infection rates and improving postoperative rehabilitation processes to prevent periprosthetic fractures could play a critical role in cost reduction. Our study also emphasizes that with the aging population, the number of both primary and revision surgeries is expected to increase, underscoring the importance of healthcare systems being prepared for this trend. Prospective studies with larger sample sizes will enhance the generalizability of these findings and contribute to the development of cost-effective strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. All authors commented on previous versions of the manuscript. All authors reviewed the manuscript.O.E.B: Wrote the main manuscript, conceived and design the analysis, final approval of the version to be published, collected the data, collected the data, wrote the paper, prepared the figures and tables, M.B.G: Wrote the main manuscript, collected the data, collected the data, wrote the paper, prepared the figures and tables, H.K.: Performed the analysis, contributed data or analysis tools, K.B: Performed the analysis, contributed data or analysis tools, B.A.E: Performed the analysis, collected the data, E.D: Performed the analysis and statistics, prepared the figures and tables\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAnderson PM et al (2022) Total hip arthroplasty in geriatric patients - a single-center experience. SICOT J 8:12\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgarwal N, To K, Khan W (2021) Cost effectiveness analyses of total hip arthroplasty for hip osteoarthritis: A PRISMA systematic review. Int J Clin Pract 75(2):e13806\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChin G et al (2016) Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis. J Arthroplasty 31(2):362\u0026ndash;367\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLavernia CJ et al (2015) The Cost-Utility of Total Hip Arthroplasty: Earlier Intervention, Improved Economics. J Arthroplasty 30(6):945\u0026ndash;949\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVanhegan IS et al (2012) A financial analysis of revision hip arthroplasty: the economic burden in relation to the national tariff. J Bone Joint Surg Br 94(5):619\u0026ndash;623\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKurtz S et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780\u0026ndash;785\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYenigul AE et al (2023) Comparison of patients undergoing revision total hip arthroplasty and patients undergoing re-revision. Eur Rev Med Pharmacol Sci 27(11):5053\u0026ndash;5058\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheth NP et al (2013) Acetabular bone loss in revision total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg 21(3):128\u0026ndash;139\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLie SA et al (2004) Failure rates for 4762 revision total hip arthroplasties in the Norwegian Arthroplasty Register. J Bone Joint Surg Br 86(4):504\u0026ndash;509\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClohisy JC et al Reasons for revision hip surgery: a retrospective review. Clin Orthop Relat Res, 2004(429): p. 188\u0026ndash;192\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBozic KJ et al (2005) Hospital resource utilization for primary and revision total hip arthroplasty. J Bone Joint Surg Am 87(3):570\u0026ndash;576\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaradit Kremers H et al (2015) Prevalence of Total Hip and Knee Replacement in the United States. J Bone Joint Surg Am 97(17):1386\u0026ndash;1397\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeber M et al (2018) Revision Surgery in Total Joint Replacement Is Cost-Intensive. Biomed Res Int, 2018: p. 8987104\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBozic KJ, Ries MD (2005) The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am 87(8):1746\u0026ndash;1751\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLindahl H et al (2005) Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty 20(7):857\u0026ndash;865\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhillips JR, Morac BC, Manktelov CG (2011) What is the financial cost of treating periprosthetic hip fractures? Injury 42(2):146\u0026ndash;149\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones AR et al (2016) The economic impact of surgically treated peri-prosthetic hip fractures on a university teaching hospital in Wales 7.5-year study. Injury 47(2):428\u0026ndash;431\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelmer G et al (2021) Reasons for Revision: Primary Total Hip Arthroplasty Mechanisms of Failure. J Am Acad Orthop Surg 29(2):78\u0026ndash;87\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDemir B, Rakkad AN, Ayasgil N, \u0026Ccedil;atal M, Azboy B (2024) Are Recommendations Followed after Total Hip Arthroplasty? A Questionnaire. Istanbul Med J 25(1):31\u0026ndash;35\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Distribution of patients\u0026apos; demographic data\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"636\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary total hip arthroplasty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRevision total hip arthroplasty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e737 (78.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e205 (21.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e60.70 \u0026plusmn; 13.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e65.8 \u0026plusmn; 14.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender (Male/Female)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e74 (7.9%)/ 131 (13.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e227 (24.1%)/ 510 (54.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSide (Right/Left)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e337 (35.8%)/ 400 (42.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e100 (10.6%)/ 105 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTablo 2:\u0026nbsp;\u003c/strong\u003eComparison of complication rates in primary and revision hip arthroplasty\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbsence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary Hip Arthroplasty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e44(6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e693(94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e737(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRevision Hip Arthroplasty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e43(21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e162(79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e205(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Comparison of cost and follow-up time in revision patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(month)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCost\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(TL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeptic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e63 (31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e117,5\u0026plusmn;12.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e23016,21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAseptic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e113 (55% )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e125,1\u0026plusmn;9.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e12139,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeriprosthetic fracture\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e29 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e62.3\u0026plusmn;15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e17975,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Etiological distribution of revision cases according to age groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeptic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAseptic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeriprosthetic Fracture\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYaş\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026le;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e4 (36.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e7 (63.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e11 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e41-50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e6 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e5 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e3 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e14 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e51-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e21 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e35 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e56 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e61-70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e14 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e10 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e11 (31.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e35 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e71-80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e18 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e31 (53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e10 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e59 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026ge;81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e25 (83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e5 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e30 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eToplam\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e63 (31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e113 (55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e29 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e205 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u0026nbsp;\u003c/strong\u003eType of component changed in revision cases and cost analysis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of patient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCost (TL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e114 (%55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e18528\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcetabulum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e51 (%24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e9869,59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemur\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e25 (%12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e13938,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiner\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e15 (%7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e6822,74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Total Hip Arthroplasty, Revision Hip Arthroplasty, Cost Analysis, Etiology of Revision","lastPublishedDoi":"10.21203/rs.3.rs-6691854/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6691854/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTotal hip arthroplasty (THA) is widely recognized as a landmark surgical procedure of the 20th century, frequently performed due to its favorable outcomes. However, revision hip arthroplasty is more complex, associated with higher complication rates and increased healthcare costs compared to primary procedures.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aims to analyze the costs associated with revision hip arthroplasty, identify factors influencing these costs, and evaluate the impact of revision etiologies on financial burden. Additionally, it seeks to raise awareness about improving the longevity of primary THA and contribute to the development of a national joint registry.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective analysis was conducted on patients undergoing revision (n\u0026thinsp;=\u0026thinsp;205) and primary (n\u0026thinsp;=\u0026thinsp;737) total hip arthroplasty at a single center between 2017\u0026ndash;2022. Data including demographics, comorbidities, hospital length of stay, surgical details, complications, and cost information were extracted from hospital records. Statistical analyses were performed to assess differences in cost and clinical variables between groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe median cost for revision THA was significantly higher than for primary THA (15,069.77 TL vs. 8,716.47 TL, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Increased comorbidity burden was associated with higher costs in both groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The most common revision indications were aseptic loosening, infection, and periprosthetic fractures, with septic and fracture-related revisions incurring significantly greater costs than aseptic cases. Two-stage revision surgeries were more costly than single-stage procedures (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, revision cases had longer median hospital stays compared to primary cases (11.5 vs. 3 days, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eRevision hip arthroplasty imposes substantially greater financial burden than primary procedures, influenced by complications, surgical approach, and revision etiology. Preventive strategies targeting infection reduction and complication minimization are crucial to control escalating costs. With an aging population, the demand for both primary and revision THA is expected to rise, underscoring the need for effective health system planning and cost management strategies.\u003c/p\u003e","manuscriptTitle":"Cost Analysis of Revision Total Hip Arthroplasty: Influencing Factors and Etiological Impact","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-04 09:43:49","doi":"10.21203/rs.3.rs-6691854/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a0aded0e-b89b-4989-bd58-f3e51060ab29","owner":[],"postedDate":"June 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-30T14:08:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-04 09:43:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6691854","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6691854","identity":"rs-6691854","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}