Hospitals Lose Money on Complex Knee Revisions
A study of 2,265 revision total knee replacements found hospitals are losing money on complex cases performed in the hospital setting.
Updated on Nov. 8, 2026 in Healthcare
Researchers reviewed 2,265 revision total knee arthroplasty cases from 2017 to 2025 and found median total costs ranged widely by complication type. Reimbursement for these procedures was found to be substantially lower than their cost, leaving hospitals financially exposed.
Why it matters
The findings arrive as CMS has proposed removing revision total knee arthroplasty from the inpatient-only list, a change that would shift where these procedures are performed. Fewer surgeons and facilities may be available to care for complex revision patients in the coming years.
Median total costs for revision knee replacements ranged from $77,659 for joint infection to $100,558 for periprosthetic fracture across 2,265 cases reviewed from 2017 to 2025. Specialty hospitals reported a median cost of just $11,784, compared with $87,109 at community hospitals and $80,409 at tertiary hospitals, and the study did not address whether reimbursement rates would close that gap.
The players
Centers for Medicare & Medicaid Services (CMS)
The federal agency that administers Medicare and proposed removing revision total knee arthroplasty from the inpatient-only list.
American Association of Hip and Knee Surgeons
A professional medical society of orthopedic surgeons that hosted the annual meeting where the study results were presented.
The details
Researchers retrospectively reviewed the data and categorized patients by hospital setting and revision indication. Specialty hospitals managed lower-complexity revision cases among healthier patients, while the costliest complex revisions were concentrated in higher-cost settings, the findings were presented at the American Association of Hip and Knee Surgeons Annual Meeting.
Timeline
2017 to 2025: Period of revision total knee arthroplasty cases reviewed in the study.
2026: Proposed Outpatient Prospective Payment System rate that would apply to the procedures.
Market Landscape
CMS's proposal to remove revision total knee arthroplasty from the inpatient-only list would move these procedures into outpatient settings under the Outpatient Prospective Payment System. The study's cost data suggest that shift would reshape which facilities are willing to perform complex revisions.
Patients needing complex knee revisions may find fewer surgeons and facilities available as hospitals reassess which procedures they can afford to perform. Changes to where these surgeries are covered could affect both out-of-pocket costs and access to care.
The takeaway
Reimbursement rates and actual procedure costs are diverging for complex joint revisions, and that gap may determine who is able to deliver this care. Patients facing a revision should ask their surgeon where the procedure will be performed and how it is covered.
Further reading
For broader context on how payment rules shape hospital operations, see Healthcare.
Source note: This article includes information reported by Healio.
