LAUSR

In healthcare, value has been defined as the condition-specific medical outcome per dollar spent [7]. In terms of quality of life, THA has proven to be one of the most valuable and cost-effective procedures in modern medicine [5, 6]. We know that patients who undergo THA have a higher life expectancy compared to the general population [4, 8, 9]. Why? In part because patients who undergo THA are medically prescreened for elective surgery [8], resulting in the population of patients undergoing hip arthroplasty generally being healthier than others in their age group. Additionally, though, patients with THAs can improve cardiovascular fitness and functional status after surgery [8], potentially mitigating other risk factors for mortality over the long-term [1]. The latter, in particular, increases the value of the THA procedure, which is important because in the era of bundled payments and value-drive healthcare, the merit (value) of THA is coming under more and more scrutiny. Nevertheless, the benefits of THA must always be considered against the outcome of not undergoing an elective THA. The current study by Kremers and colleagues examined life expectancy after revision THA, where the improvement in life expectancy is not as well characterized as it is among patients undergoing elective primary THA. To my knowledge, this paper is the first longer-term study that reports patient longevity after revision THA according to indication (loosening, wear, instability, infection, and fracture) and year of surgery.