Summary: Revision total hip arthroplasty is a complex, time-consuming, technically challenging surgical procedure that frequently requires high levels of hospital resources. This study reports the actual costs and reimbursement to the hospital for a stratified group of revision total hip arthroplasty patients based on a severity index. The clinical and financial records of 49 patients (51 hips) stratified by complexity of revision were reviewed. Multiple clinical variables were studied. Financial review included both the actual fixed and variable costs associated with each procedure. Hospital costs associated with revision total hip arthroplasty were significantly greater in the most complex revisions and in older patients. The use of bone grafting techniques on the femur resulted in significantly greater costs. The average loss to the hospital was $5,402 per procedure with a range of $5,657 profit to $28,780 loss. Procedures in patients younger than 65 years had an average loss of $1,133. All procedures in patients who were 65 years or older resulted in a loss to the hospital (average loss, $8,617).