Conference Coverage

Revision Knee Arthroplasty Costs Exceed CMS Reimbursement Rates

Edited by:
Ashton L. Stahl

Key Highlights

  • Median revision costs across all indications exceeded the FY2026 inpatient reimbursement rates cited in the abstract.
  • Periprosthetic fracture revisions had the highest median total cost, at $100,558.
  • Specialty hospitals reported lower costs while treating selected patients with lower-complexity cases.

Revision total knee arthroplasty (rTKA) costs exceeded the Centers for Medicare & Medicaid Services (CMS) inpatient reimbursement rates cited across all revision indications examined, according to an abstract from the American Association of Hip and Knee Surgeons (AAHKS) 2026 Annual Meeting. Specialty hospitals reported substantially lower costs than community and tertiary hospitals, but they treated patients with less complex cases.

The researchers examined these differences in the context of CMS’s proposed removal of rTKA from the Inpatient Only list and reimbursement structures that do not distinguish among revision indications. Their retrospective analysis included 2,265 rTKA cases performed from 2017 through 2025 at a high-volume institution. Cases were stratified by hospital setting and revision indication; continuous variables were compared using t-tests or Mann–Whitney U tests, and categorical variables using chi-square or Fisher’s exact tests.

Study Findings

The cohort included 1,955 community hospital cases, 171 tertiary hospital cases, and 139 orthopedic specialty hospital cases. Revision indications were periprosthetic joint infection (PJI; n=1,155), mechanical complication (n=702), aseptic loosening (n=303), and periprosthetic fracture (n=105). Periprosthetic fracture revisions had the highest median total cost ($100,558), compared with $88,572 for mechanical complications (P = .003), $87,415 for aseptic loosening (P = .003), and $77,659 for PJI (P < .001).

Median costs at specialty hospitals were $11,784, compared with $87,109 at community hospitals and $80,409 at tertiary hospitals (both P < .001). Specialty, community, and tertiary hospitals had mean lengths of stay of 1.24, 4.37, and 4.07 days, respectively, and age-adjusted CCI scores of 3.36, 4.19, and 4.25 (both comparisons P < .001). Second revisions accounted for 0.72%, 15.7%, and 8.19% of cases, respectively; third-or-later revisions accounted for 0%, 6.6%, and 2.34% (both comparisons P < .001).

Clinical Implications

The study authors suggest that reimbursement does not align with rTKA costs across indications and hospital settings. Median costs for every indication exceeded the cited FY2026 inpatient diagnosis-related group (DRG) payments: $35,146 for DRG 466, $23,809 for DRG 467, and $18,555 for DRG 468. Proposed PJI-specific inpatient DRGs 403 and 404, approximately $39,165 and $21,068, also fell below the median PJI cost.

The authors emphasized that community and tertiary hospital costs greatly exceeded DRG reimbursement. Although specialty hospital costs were below the proposed 2026 Outpatient Prospective Payment System rate of $13,254 for CPT 27487, those hospitals treated carefully selected, lower-complexity patients.

Expert Commentary

“Taken together, blanket outpatient designations risk persistent negative margins and threaten access to complex revision care,” the researchers concluded.

Reference

Krueger CA, Kugelman DN, Khan I, Courtney PM, Patel V. Total knee revisions cannot afford to go outpatient: implications of CMS reimbursement policies. Paper #24. Abstract presented at the American Association of Hip and Knee Surgeons Annual Meeting, November 5–8, 2026, Dallas, TX.