Implant standardization for total hip arthroplasty. An implant selection and a cost reduction program
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W L Healy1, F M Kirven, R Iorio
1Department of Orthopaedic Surgery, Lahey Clinic, Burlington, Massachusetts 01805, USA.
Insights
Implementing a hip implant standardization program can significantly reduce total hip arthroplasty costs. This approach matches implant selection to patient demand, potentially saving 25.7% on implant expenses without compromising care.
Area of Science:
- Orthopedic surgery
- Health economics
- Medical device management
Background:
- Total hip arthroplasty (THA) faces federal cost control due to high expenses and increasing demand.
- Hip implant costs represent a significant driver of THA expenditure.
- Previous cost control measures focused on utilization and service volume.
Purpose of the Study:
- To develop and evaluate the Lahey Clinic Hip Implant Standardization Program for objective hip implant selection.
- To assess the potential of this program to reduce hospital costs for hip implants.
- To ensure patient care is not compromised by cost-saving measures.
Main Methods:
- Developed a standardization program assigning patients to four demand categories based on age, weight, activity, health, and bone stock.
- Retrospectively applied the program to 103 total hip arthroplasties performed in 1991.
- Utilized analysis of variance to assess the significance of patient variables and demand categories.
Main Results:
- Patient variables and demand categories were statistically significant groupings.
- The standardization program demonstrated a potential cost reduction of 25.7% for hip implants.
- The program aims to match implant capacity with patient-specific demands.
Conclusions:
- The Lahey Clinic Hip Implant Standardization Program offers a viable strategy for reducing THA costs.
- Matching implant selection to patient demand can lead to significant cost savings.
- Further prospective studies are needed to validate the long-term effectiveness and outcomes of this program.
Abstract:
Total hip arthroplasty (THA) has been targeted by the United States federal government for cost control because of its high cost and rising incidence in the aging population. The hospital cost for THA during the 1980s was controlled by utilization review and a reduction in the volume of services delivered for each THA. The single largest increase in the cost of THA during the 1980s was the cost of hip implants. The Lahey Clinic Hip Implant Standardization Program was developed to provide objective guidelines for hip implant selection. These guidelines are based on the demands a patients is expected to place on his or her hip prosthesis. Because not every patient requires an expensive high-demand hip prosthesis, the standardization program also has the potential to reduce the hospital cost for hip implants without compromising patient care. Patients are assigned to four demand categories based on five objective criteria: age, weight, expected activity, general health, and bone stock. Selection of the prosthesis in each of the four demand categories is intended to match the implant's capacity with expected patient demand. The standardization program was retrospectively applied to 103 THAs performed during 1991. Analysis of variance demonstrated that patient variables and demand categories were statistically significant groupings. The cost of hip implants would have been reduced by 25.7% with the Lahey Clinic Hip Implant Standardization Program. A prospective outcome study is required to determine the long-term validity of this standardization program.