Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2015; 6(10): 750-753
Published online Nov 18, 2015. doi: 10.5312/wjo.v6.i10.750
Conversion total hip arthroplasty: Primary or revision total hip arthroplasty
Ran Schwarzkopf, Mahta Baghoolizadeh
Ran Schwarzkopf, Department of Orthopaedic Surgery, Division of Adult Reconstruction, NYU Hospital for Joint Diseases, NYU Langon Medical Center, New York, NY 10003, United States
Mahta Baghoolizadeh, School of Medicine, University of California, Irvine, CA 92697, United States
Author contributions: Schwarzkopf R contributed to design, writing, review and revision; Baghoolizadeh M contributed to design, data collection and analysis, writing, revision.
Conflict-of-interest statement: Mahta Baghoolizadeh has no conflict of interest to declare; Ran Schwarzkopf has no conflict of interest related to this work, but is a consultant for Smith and Nephew, Stryker and Intelijoint.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ran Schwarzkopf, MD, MSc, Department of Orthopaedic Surgery, Division of Adult Reconstruction, NYU Hospital for Joint Diseases, NYU Langone Medical Center, 301 East 17th Street, New York, NY 10003, United States. schwarzk@gmail.com
Telephone: +1-212-5986000 Fax: +1-212-2632290
Received: May 14, 2015
Peer-review started: May 16, 2015
First decision: July 10, 2015
Revised: August 11, 2015
Accepted: September 7, 2015
Article in press: September 8, 2015
Published online: November 18, 2015
Abstract

Total hip arthroplasty (THA) is an increasingly common procedure among elderly individuals. Although conversion THA is currently bundled in a diagnosis related group (DRG) with primary THA, there is a lack of literature supporting this classification and it has yet to be identified whether conversion THA better resembles primary or revision THA. This editorial analyzed the intraoperative and postoperative factors and functional outcomes following conversion THA, primary THA, and revision THA to understand whether the characteristics of conversion THA resemble one procedure or the other, or are possibly somewhere in between. The analysis revealed that conversion THA requires more resources both intraoperatively and postoperatively than primary THA. Furthermore, patients undergoing conversion THA present with poorer functional outcomes in the long run. Patients undergoing conversion THA better resemble revision THA patients than primary THA patients. As such, patients undergoing conversion THA should not be likened to patients undergoing primary THA when determining risk stratification and reimbursement rates. Conversion THA procedures should be planned accordingly with proper anticipation of the greater needs both in the operating room, and for in-patient and follow-up care. We suggest that conversion THA be reclassified in the same DRG with revision THA as opposed to primary THA as a step towards better allocation of healthcare resources for conversion hip arthroplasties.

Keywords: Conversion total hip arthroplasty, Primary total hip arthroplasty, Revision total hip arthroplasty, Hip fracture, Post-operative complications

Core tip: Conversion total hip arthroplasty (THA) is a challenging procedure that requires more resources both intraoperatively and postoperatively than primary THA. As such, these procedures should be planned to anticipate the greater needs in the operating room, and for in-patient and follow-up care. Patients undergoing conversion THA should not be likened to patients undergoing primary THA when determining risk stratification and reimbursement rates. We suggest that conversion THA be reclassified in the same group with revision THA as a step towards better allocation of hospital resources.