Independent, sourced patient educationInformedSurgery
Hip Replacement Explained
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All topics
  1. What it is
  2. Who it helps
  3. Timing
  4. The procedure
  5. What a hemiarthroplasty is
  6. Hemi vs total hip
  7. Recovery after hip fracture
  8. Patient journey
  9. Recovery supplies
  10. Finding a surgeon
  11. Insurance and costs
  12. Questions to ask
  13. Implant designs
  14. Side-by-side
  15. Robotics and navigation
  16. US manufacturers
  17. What the evidence says
  18. Value analysis
  19. Resources
  20. Glossary
  21. References

For hospitals

Value analysis considerations

Implant price is an important part of hip replacement cost, but post-acute care, length of stay, complications and revisions drive much of the rest of the episode.

Evidence relevant to value
  • Implant cost under bundles. In one health system's bundled payment program, implant costs fell an average of $1,921 (29%) per case and were the largest source of hospital savings; total episode spending fell 20.8%.34
  • Medicare CJR. In the first year of the randomized CJR evaluation, discharge to institutional post-acute care fell 2.9 percentage points; total episode spending was not significantly different.32 Over two years, Part A spending fell $582 per episode (2.5%), driven by post-acute care, with no change in readmissions or complications.33
  • TEAM. CMS's mandatory Transforming Episode Accountability Model includes lower extremity joint replacement and surgical hip and femur fracture treatment episodes in selected hospitals.51
  • Outpatient pathways. In selected patients, outpatient arthroplasty showed similar complications and readmissions with an average cost reduction of $6,797 (hip and knee pooled).31
  • Complication costs. Hip PJI hospital costs are projected at $753 million a year in the US by 2030.10
  • Technology. Robotic systems reduce cup outliers; durable outcome and cost evidence is limited and partly industry-authored.21,23

Questions for the committee

  • What registry survivorship data exist for each stem and cup, and for this exact combination?
  • For dual mobility: which patient groups will it be used in, and how will that be tracked?
  • For hip fracture: are cemented stems available on every shift, and is the team trained in cementing?
  • For robotics or navigation: what is the total cost per case including disposables, imaging and OR time, and what outcome will we measure?
  • Does the precautions protocol match current evidence, and what equipment is issued by default?17,18

Sources for this page

  1. Premkumar A, et al. Projected economic burden of periprosthetic joint infection of the hip and knee in the United States. J Arthroplasty. 2021;36(5):1484-1489.e3. doi:10.1016/j.arth.2020.12.005
  2. Smith TO, et al. Assistive devices, hip precautions, environmental modifications and training to prevent dislocation and improve function after hip arthroplasty. Cochrane Database Syst Rev. 2016;7(7):CD010815. doi:10.1002/14651858.CD010815.pub2
  3. Korfitsen CB, et al. Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients. Acta Orthop. 2023;94:141-151. doi:10.2340/17453674.2023.11958
  4. Arun Kumar G, et al. Robotic-assisted versus conventional manual total hip arthroplasty: a systematic review and meta-analysis of component position accuracy, Lewinnek zone outliers, and early dislocation rates. J Robot Surg. 2026;20(1). doi:10.1007/s11701-026-03678-x
  5. Sarrel K, et al. Understanding economic analysis and cost-effectiveness of CT scan-guided, 3-dimensional, robotic-arm assisted lower extremity arthroplasty: a systematic review. J Comp Eff Res. 2024;13(4):e230040. Industry co-authors. doi:10.57264/cer-2023-0040
  6. Bemelmans YFL, et al. Safety and efficacy of outpatient hip and knee arthroplasty: a systematic review with meta-analysis. Arch Orthop Trauma Surg. 2022;142(8):1775-1791. doi:10.1007/s00402-021-03811-5
  7. Finkelstein A, et al. Mandatory Medicare bundled payment program for lower extremity joint replacement and discharge to institutional postacute care: interim analysis of the first year of a 5-year randomized trial. JAMA. 2018;320(9):892-900. doi:10.1001/jama.2018.12346
  8. Haas DA, et al. Evaluation of economic and clinical outcomes under Centers for Medicare & Medicaid Services mandatory bundled payments for joint replacements. JAMA Intern Med. 2019;179(7):924-931. doi:10.1001/jamainternmed.2019.0480
  9. Navathe AS, et al. Cost of joint replacement using bundled payment models. JAMA Intern Med. 2017;177(2):214-222. doi:10.1001/jamainternmed.2016.8263
  10. Centers for Medicare & Medicaid Services. Transforming Episode Accountability Model (TEAM). cms.gov/priorities/innovation/innovation-models/team-model

All references