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Open Access Open Badges Research article

Resource utilization and costs before and after total joint arthroplasty

Kevin J Bozic12*, Brett Stacey3, Ariel Berger4, Alesia Sadosky5 and Gerry Oster4

Author Affiliations

1 University of California, San Francisco, Department of Orthopaedic Surgery, 500 Parnassus Ave. MUW320, San Francisco, CA 94143-0728, USA

2 University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California St., San Francisco, CA 94143-0936, USA

3 Oregon Health & Science University, Portland, OR, USA

4 Policy Analysis Inc., Brookline, MA, USA

5 Pfizer Inc., New York, NY, USA

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BMC Health Services Research 2012, 12:73  doi:10.1186/1472-6963-12-73

Published: 23 March 2012



The purpose of this study was to compare pre- and post-surgical healthcare costs in commercially insured total joint arthroplasty (TJA) patients with osteoarthritis (OA) in the United States (U.S.).


Using a large healthcare claims database, we identified patients over age 39 with hip or knee OA who underwent unilateral primary TJA (hip or knee) between 1/1/2006 and 9/30/2007. Utilization of healthcare services and costs were aggregated into three periods: 12 months "pre-surgery," 91 days "peri-operative," and 3 to 15 month "follow-up," Mean total pre-surgery costs were compared with follow-up costs using Wilcoxon signed-rank test.


14,912 patients met inclusion criteria for the study. The mean total number of outpatient visits declined from pre-surgery to follow-up (18.0 visits vs 17.1), while the percentage of patients hospitalized increased (from 7.5% to 9.8%) (both p < 0.01). Mean total costs during the follow-up period were 18% higher than during pre-surgery ($11,043 vs. $9,632, p < 0.01), largely due to an increase in the costs of inpatient care associated with hospital readmissions ($3,300 vs. $1,817, p < 0.01). Pharmacotherapy costs were similar for both periods ($2013 [follow-up] vs. $1922 [pre-surgery], p = 0.33); outpatient care costs were slightly lower in the follow-up period ($4338 vs. $4571, p < 0.01). Mean total costs for the peri-operative period were $36,553.


Mean total utilization of outpatient healthcare services declined slightly in the first year following TJA (exclusive of the peri-operative period), while mean total healthcare costs increased during the same time period, largely due to increased costs associated with hospital readmissions. Further study is necessary to determine whether healthcare costs decrease in subsequent years.