Medicare fails to compensate additional surgical time and effort associated with revision arthroplasty.

In comparison to primary total knee arthroplasty, surgical time was 1.8 times greater for all knee revisions and 2.4 times greater for complex knee revisions. Knee revisions had an 8.5% higher rate of 90-day repeat procedures. In comparison to primary total hip arthroplasty, surgical time was 1.8 greater for all hip revisions and 2.6 fold greater for complex hip revisions. Hip revisions had a 3.4% higher rate of 90-day repeat procedures. Practices based on revisions or complex revisions alone would see a 32% and 50% decrease in reimbursement respectively compared to the ones based on primary arthroplasty. The projected future increase in primary arthroplasties and the relative incentive to perform primary arthroplasty may soon put patient access to physicians willing to perform revision arthroplasty at risk.