Primary hip arthroplasty costs are greater in low-volume than in high-volume Canadian hospitals
Related Experiment Video
Updated: Aug 16, 2026
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Paul Martineau1, Kristian B Filion, Olga L Huk
1Division of Orthopedic Surgery, Jewish General Hospital/McGill University, Montreal, Quebec, Canada.
Insights
High-volume hospitals significantly reduce total hip arthroplasty costs. Performing this procedure in high-volume centers lowers overhead, direct, and total in-hospital expenses, offering a cost-effective solution for arthritis treatment.
Area of Science:
- Orthopedic Surgery
- Health Economics
- Hospital Management
Background:
- Total hip arthroplasty (THA) is a successful treatment for hip arthritis.
- Cost containment is a significant focus for THA procedures.
- Variations in hospital volume may impact procedure costs.
Purpose of the Study:
- To compare the total in-hospital costs of primary total hip arthroplasties between high-volume and low-volume Canadian hospitals.
- To identify cost drivers in primary total hip arthroplasties based on hospital volume.
Main Methods:
- Retrospective analysis of patient-level in-hospital costs.
- Data extracted from the cost accounting systems of three Canadian hospitals.
- Comparison of costs for 940 primary total hip arthroplasties stratified by annual hospital volume (high-volume >= 300; low-volume < 300).
Main Results:
- High-volume hospitals had significantly lower mean costs: overhead ($1380 vs $2432), direct ($3023 vs $4952), and total ($4403 vs $7385).
- Differences in direct costs, largely due to implant expenses, were the primary driver of cost disparity.
- Lower overhead and direct costs contributed to overall lower total costs in high-volume settings.
Conclusions:
- Primary total hip arthroplasties are more cost-effective when performed in high-volume Canadian hospitals.
- Performing THA in high-volume centers appears to be an effective strategy for cost containment.
- Focusing on implant costs within direct expenses could further optimize cost-efficiency.
Abstract:
Despite the widespread success of total hip arthroplasties for treatment of arthritis of the hip, the procedure continues to be targeted for cost control. Our objective was to compare the total in-hospital cost of primary total hip arthroplasties in high-volume and low-volume hospitals. Data concerning the patient-level in-hospital costs of 940 consecutive primary total hip arthroplasties were extracted from the cost accounting system of three Canadian hospitals. Mean in-hospital costs for patients having total hip arthroplasties in a high-volume institution (> or = 300 total hip arthroplasties/year) compared with two low-volume Canadian institutions (< 300 total hip arthroplasties/year) were: overhead costs 1380 US dollars +/- 35 US dollars versus 2432 US dollars +/- 49 US dollars; direct costs 3023 US dollars +/- 93 US dollars versus 4952 US dollars +/- 91 US dollars and total costs 4403 US dollars +/- 117 US dollars versus 7385 US dollars +/- 1 US dollar 38, respectively (all comparisons in US dollars). Lower overhead and direct and total costs were found for primary total hip arthroplasties done in a high-volume Canadian hospital compared with the low-volume centers. Differences in direct costs, made up in large part by the implant cost, accounted for most of the disparity. As total hip arthroplasties continue to be scrutinized for cost containment, doing the procedure in a high-volume center seems to be an effective method of controlling costs.
