Assessing the value of a total joint replacement

Abstract

Total joint arthroplasty (TJA) continues to be one of the most successful surgical interventions in medicine. Demand is growing rapidly, placing an increasingly heavy cost burden on national health systems. Despite the popularity of these surgeries, high-quality cost-effectiveness studies evaluating TJA are few in number. This article summarizes the current literature on value in arthroplasty, identifying the various factors affecting costs and outcomes, and suggesting how policy makers can influence utilization of TJA to further improve value to society.

Bundled Payments in Total Joint Replacement: Keeping Our Care Affordable and High in Quality

“…Consequently, strategies for lowering implant costs should be a focus, especially considering many higher-cost prostheses frequently have unproven clinical benefit. An overall decrease in the variability and reduction in the cost of implants is possible through the creation of implant selection protocols and resource use committees, giving hospitals improved negotiating power with device manufacturers [5]. This was found to be true in a Canadian model in which higher-volume hospitals were able to minimize costs more effectively than low-volume hospitals through negotiating power [51].…”

“…The incidence of these procedures is projected to rise to over 4,000,000 per year within the next two decades [3,4]. Despite being cost-effective [5,6] and reliable for regaining lower extremity joint function and improving quality of life [7], TJAs represented over seven billion dollars in cost to the Centers for Medicare & Medicaid Services (CMS) in 2014 [8], and they currently account for more Medicare expense than any other inpatient procedure [9]. As such, any increase in the number of TJAs performed annually threatens to impose an enormous economic burden on the US healthcare system.…”

Total joint arthroplasty: practice variation of physiotherapy across the continuum of care in Alberta

“…Inadequate rehabilitation is likely a major contributor to residual pain [7], muscle weakness, functional limitations and poor HRQL reported in approximately 25 % of individuals after total joint arthroplasty (TJA) [8–10]. Comprehensive and timely rehabilitation for TJA is needed to maximize recovery from this elective surgical procedure for hip and knee arthritis [11]. …”

Hypothyroidism Increases 90-Day Complications and Costs Following Primary Total Knee Arthroplasty

“…Total knee arthroplasty (TKA) is a cost-effective [1,2] option for reducing pain and improving function among patients with end-stage knee arthritis [3]. Not surprisingly, it is one of the most frequently performed procedures in the United States [4–6], imposing an enormous economic burden on the healthcare system [7].…”