Hospital Costs of Primary and Revision Total Knee Arthroplasty in Public Health Services in the State of São Paulo: A Multicenter Study
D.U. Munhoz, P.N. Giglio, A.B. Mestriner, A.R.C. Segalla, M.K. Demange, R.G. GobbiObjective:
To analyze and compare the direct hospital costs of primary and revision total knee arthroplasty (TKA) performed in public hospitals in the state of São Paulo, and to evaluate the economic impact of complicated cases requiring revision surgery.
Methods:
This multicenter, retrospective observational study included patients who underwent primary TKA between 2008 and 2018 in four tertiary public hospitals. Cost data were obtained from institutional financial records and included hospital stay, surgical materials and implants, medications, and operating room charges. Costs were calculated for uncomplicated primary TKA, revision TKA, and the cumulative cost of complicated cases requiring both procedures.
Results:
A total of 433 patients (534 procedures) were analyzed. The mean hospital cost of an uncomplicated primary TKA was R$12,402.89, with materials accounting for the largest proportion of expenses (42.2%), followed by operating room charges (27.7%) and hospital stay (26.9%). The mean cost of revision TKA was R$23,655.51, nearly twice that of the primary procedure. In revision surgeries, hospital stay became the main cost driver, representing 42.7% of total expenses. The cumulative cost of a complicated case reached R$36,058.40, corresponding to a 191% increase compared with an uncomplicated primary TKA.
Conclusion:
Revision total knee arthroplasty imposes a substantial economic burden on the public health system, with costs nearly tripling when complications occur. These findings highlight the importance of strategies focused on preventing prosthetic failure (particularly periprosthetic infection) and optimizing perioperative care to improve sustainability and resource allocation in public hospitals.