Revision Total Joint Arthroplasty Places a Disproportionate Burden on Surgeons: A Comparison Using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX)

INTRODUCTION:Perceived surgeon workload of performing primary and revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) is challenging to quantify. The National Aeronautics and Space Administration-Task Load Index (NASA-TLX) survey was developed to quantify experiences following aviation and has been applied to healthcare fields. Our purposes were to: 1) quantify the workload endured by surgeons who are performing primary and revision TKA and THA and 2) compare these values to their Center for Medicare & Medicaid Services (CMS) reimbursement. METHODS:A prospective cohort of 5 fellowship-trained adult reconstruction surgeons completed NASA-TLX surveys following primary and revision TKA/THA cases. A total of 122 surveys consisting of 70 TKA (48 primaries and 22 revisions) and 55 THA surveys (38 primaries and 17 revisions) were completed. Patient demographics and surgical variables were recorded. Final NASA-TLX workloads were compared to 2021 CMS work relative value units (RVU). RESULTS:Compared to primary TKA, revision TKA had 176% increased intraoperative workload (P<0.001), 233% increased mental burden (P<0.001), and 150% increased physical burden (P<0.001). Compared to primary THA, revision THA had 106% increased intraoperative workload (P<0.001), 96% increased mental burden (P<0.001), and 91% increased physical burden (P<0.001). Operative time was higher in revision versus primary TKA (118 versus 84.5 minutes, P=0.05) and THA (150 versus 115 minutes, P=0.001). Based upon 2021 CMS data, revision TKA and THA would need to be compensated by an additional 36 and 12.3%, respectively, to parallel intraoperative efforts. CONCLUSION:Revision hip and knee arthroplasty places a major mental and physical workload upon surgeons and is disproportionately compensated by CMS.