Clinical Orthopaedics and Related Research®

, Volume 470, Issue 4, pp 1065–1072 | Cite as

Measuring the Value of Total Hip and Knee Arthroplasty: Considering Costs Over the Continuum of Care

  • Deborah A. Marshall
  • Tracy Wasylak
  • Hoa Khong
  • Robyn D. Parker
  • Peter D. Faris
  • Cy FrankEmail author
Symposium: Value Based Healthcare



Controlling escalating costs of hip (THA) and knee arthroplasty (TKA) without compromising quality of care has created the need for innovative system reorganization to inform sustainable solutions.


The purpose of this study was to inform estimates of the value of THA and TKA by determining: (1) the data sources data required to obtain costs across the care continuum; (2) the data required for different analytical perspectives; and (3) the relative costs across the continuum of care.


Within the context of a pragmatic randomized controlled trial comparing alternative care pathways, we captured healthcare resource use: (1) 12 months before surgery; (2) inpatient; (3) acute recovery; and (4) long-term recovery 3 and 12 months postsurgery. We established a standardized costing model to reflect both the healthcare payer and patient perspectives.


Multiple data sources from regional health authorities, administrative databases, and patient questionnaire were required to estimate costs across the care continuum. Inpatient and acute care costs were approximately 60% of the total with the remaining 40% incurred 12 months presurgery and 12 months postsurgery. Regional health authorities bear close to 60%, and patient costs are approximately 30% of the mean total costs, most of which were incurred after the acute inpatient stay.


To fully understand the value of an orthopaedic intervention such as THA and TKA, a broader perspective than one limited to the payer should be considered using a standardized measurement framework over a relevant time horizon and from multiple viewpoints to reflect the substantial patient burden and support sustainable improvement over the care continuum.

Level of Evidence

Level III, economic and decision analyses study. See Guidelines for Authors for a complete description of levels of evidence.


Clinical Pathway Total Joint Arthroplasty Regional Health Authority Alternative Care Measurement Framework 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Project partners were Alberta Health Services-Calgary Health Region, Capital Health Authority, and David Thompson Health Region, Alberta Orthopaedic Society, and Alberta Health and Wellness. Participating orthopaedic surgeons were Greg Abelseth, Lance Bredo, Brian Burkart, John Cinats, Kelly deSouza, Hugh Dougall, Thomas Greidanus, Kenneth James, D. W. C. (Bill) Johnston, Guy Lavoie, James Mackenzie, Ed Masson, James McMillan, Stephen Miller, Gregory O’Connor, Timothy Pierce, Rod Reikie, Lowell Van Zuiden, Donald Weber, and Jason Werle. The Safety Review Committee consisted of John Donaghy, Joe Dort, Sr, and Troy Pederson. We especially thank the patients for their time and contributions to this study.


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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Deborah A. Marshall
    • 1
    • 2
    • 3
  • Tracy Wasylak
    • 4
  • Hoa Khong
    • 2
  • Robyn D. Parker
    • 1
    • 2
  • Peter D. Faris
    • 1
    • 2
    • 4
  • Cy Frank
    • 1
    • 2
    • 3
    Email author
  1. 1.University of CalgaryCalgaryCanada
  2. 2.Alberta Bone & Joint Health InstituteCalgaryCanada
  3. 3.McCaig Institute for Bone & Joint HealthCalgaryCanada
  4. 4.Alberta Health ServicesCalgaryCanada

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