4/26/2014: Prediction. Only surgeons and hospitals with low infection rates will do total joint surgery.

The incidence of operative infection will control who will do surgery of this type in the future. The reason is that a surgical infection is very costly to treat as well as the morbidity, loss of work, even mortality.

Here are the numbers concerning infection and total knee replacement.

The relative incidence of operative infections was reported as 2.0% and 2.4% following total knee surgery.

The annual cost of infected revisions to U.S. hospitals increased from $320 million to $566 million during the study period and was projected to exceed $1.62 billion by 2020. (Kurtz SM, et al Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012 Sep; 27(8 Suppl)

The average cost of the surgical revision of an infected total knee replacement was $116,383 in the years 2001 through 2007. (Kapadia BH, et al. The Economic Impact of Periprosthetic Infections Following Total Knee Arthroplasty at a Specialized Tertiary-Care Center. J Arthroplasty. 2013 Oct 17).

Under the new rules for quality assurance under the affordable health care act (Obamacare) the hospital will eat this loss.

Another often overlooked factor for those not on Medicare have a higher deductible under Obamacare. No patient going through the prolonged treatment for post operative infection will be able to pay their deductible. It can be $1000 to $10000. This problem already exists in Germany. This is a burden on the patient if they pay. If they do not pay then the cost is shifted to the doctor and the hospital. (Haenle M. et al. Economic impact of infected total knee arthroplasty. Scientific World Journal. 2012; 2012:1 96515).

So the hospital gets the expense shifted to them. Cost shifting is major feature of government health care insurance public policy.

Therefore only hospitals and surgeons with no or very low infection rates will do total joint surgery.

Notice I said surgeons. The hospital will not be able to afford even a “large producer” who has infections. “Sorry Doctor SoandSo, we know you are a nice guy and a good surgeon, but we can not afford to underwrite the risk of your incidence of infection.”