The economics of preventing revisions in total hip replacement.

We showed that the selection of a cost-effective type of cement and method of prophylaxis against deep infections for patients undergoing total hip replacement depended on the number of arthroplasties performed each year at individual hospitals. When 100 arthroplasties were performed each year, the use of Palacos cement and systemic antibiotics reduced the total costs to the department, i.e., the cost of cement, infection prophylaxis and revisions. The use of gentamicin-impregnated cement in combination with systemic antibiotics will further reduce the risk of revision and is another cost-effective strategy. The most effective infection prophylaxis would be achieved with a combination of gentamicin-impregnated cement, systemic antibiotics and surgical enclosure. However, the additional cost of the surgical enclosure would not be offset by cost savings due to reduced risk of revisions.