Economics and cost implications of total hip and total knee arthroplasty

Richard Iorio, Feroz Osmani, Savyasachi Thakkar

Research output: Chapter in Book/Report/Conference proceedingChapter


Total joint arthroplasty (TJA) is a successful, cost-effective procedure that requires an increasing amount of healthcare resources. Decreased hospital and physician reimbursement and increased costs have put a financial strain on stakeholders involved in the delivery of TJA. Cost analysis of TJA procedures across the United States shows a wide variation in the cost of the surgery. In some cases, newer technology, with no proven track record, has increased the cost of implants, thereby contributing to the increased expense of the procedure. Medicare and Medicaid have implemented alternative payment models such as the Bundle Payment for Care Improvement Initiative and the Comprehensive Care for Joint Arthroplasty, with the purpose of improving the quality of TJA care while reducing cost. Various quality and cost effectiveness improvement measures have been implemented by surgeons and hospitals and have proved to be effective. These programs have included patient risk optimization, multimodal pain management, blood management protocols, implant cost negotiation, and care management initiatives. The goal of these programs is to deliver TJA in a more cost-effective manner without sacrificing quality. In the future, TJA in a value-based purchasing environment will require more attention to cost-effective care delivery.

Original languageEnglish (US)
Title of host publicationOrthopaedic Knowledge Update
Subtitle of host publicationHip and Knee Reconstruction 5
PublisherWolters Kluwer Health
Number of pages10
ISBN (Electronic)9781975123819
ISBN (Print)9781975123796
StatePublished - Jan 1 2018
Externally publishedYes


  • Alternative payment models
  • Bundled payments
  • Cost effectiveness
  • Total joint arthroplasty

ASJC Scopus subject areas

  • Medicine(all)


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