Septic Revision Total Hip Arthroplasty Is Not Adequately Compensated by Work Relative Value Units

Background: Performing revision total hip arthroplasty (rTHA) for periprosthetic joint infection is complex and may require greater time and resources than aseptic revision cases. Work relative value units (RVUs) assigned may not reflect the difference in actual work required for septic revision hip cases. The purpose of this study is to compare the work effort between aseptic and septic revision hip cohorts, and determine if physicians are appropriately compensated. Methods: Data were collected through the National Surgical Quality Improvement Program database for the years 2005 to 2018 to identify all aseptic rTHA cases and septic rTHA cases. Work RVU, operation time, RVU per minute, and dollars per minute were assessed between the aseptic and septic revision hip cohorts. Univariate and multivariate analyses were used for the study. Results: The mean operation times for aseptic and septic rTHAs were 146.12 and 173.24 minutes, respectively (P < .001). This resulted in an RVU per minute of 0.257 for the aseptic revision hip cohort compared to 0.212 for the septic cohort (P < .001). Aseptic rTHA cases were valued higher with a dollars per minute of 9.28, whereas septic rTHA cases were 7.65 (P < .001). Conclusion: Although rTHA for infection is more complex and requires longer mean operative time than aseptic rTHA, physicians are not appropriately reimbursed for this challenging procedure. This inadequate RVU-based reimbursement for septic rTHA may deter physicians from performing these procedures, which could lead to decreased access to care for patients in need of rTHA for infection.