An international comparative study of total hip arthroplasty cost and practice patterns

The cost of total hip arthroplasty (THA) was assessed on a worldwide basis, with specific information obtained regarding implant type, cost, manufacturer, fixation method, as well as other clinical related practices. One hundred and ten orthopaedic surgeons representing 30 countries and 6 continents responded to the questionnaire. The average number of THAs per year per surgeon was 75 (range, 2-300). Surgeons reported using all cemented components in 35% of THAs at an average cost of $1,536 (U.S. dollars). Uncemented components were used in 31% at an average cost of $2,674, and hybrid reconstructions in 34% at an average cost of $2,114. Almost half (44%) of the respondents stated that the hospital negotiated the type and price of the implants. Most surgeons (80%) indicated they were under pressure to decrease the cost of THA and 68% were under pressure to reduce the length of patients' hospital stay. When asked for recommended ways to reduce costs, 30% stated that negotiating a reduced implant price from the supplier was the most important measure. On a worldwide basis, there is tremendous variation in the cost and availability of implants. The reported cost for identical implants from a single manufacturer can vary as much as 700%. The comments of those responding are similar to the findings of surgeons here in the United States regarding cost containment and the role of reducing the length of hospital stay as well as negotiating reduced prosthesis and supply costs. The orthopaedic surgeon's practice pattern is a major determinant of total costs.