Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 2;11(3):e041147.
doi: 10.1136/bmjopen-2020-041147.

Cost analysis of staged versus simultaneous bilateral total knee and hip arthroplasty using a propensity score matching

Ji-Fei Hou #  1   2 , Chuan Hu #  1   2 , Yun Zhang #  3 , Li-Qi Tian #  1 , Yan-Zheng Liu  4 , Chi Zhang  1   2 , Jing Li  1
Affiliations

Cost analysis of staged versus simultaneous bilateral total knee and hip arthroplasty using a propensity score matching

Ji-Fei Hou et al. BMJ Open. .

Abstract

Background: Total joint arthroplasty (TJA), including total knee arthroplasty (TKA) and total hip arthroplasty (THA), is required for many patients. This study aimed to evaluate the medical costs, length of stay (LOS), blood transfusion and in-hospital complications in patients undergoing simultaneous and staged TJA.

Methods: All patients who underwent primary bilateral TJA from 2013 to 2018 in our institute were included. The propensity score matching analysis was performed between simultaneous and staged TJA patients. The difference in medical costs, LOS, blood transfusion and in-hospital complications was compared between simultaneous and staged groups.

Results: Except for materials fees and general therapy fees, medical costs (bed fees, general therapy fees, nursing care fees, check-up and laboratory test fees, surgical fees and drug fees) were significantly lower in the simultaneous TKA, THA and TJA group. The total average medical costs in simultaneous and staged TKA groups were $15 385 and $16 729 (p<0.001), respectively; THA groups were $14 503 and $16 142 (p=0.016), respectively; TJA groups were $15 389 and $16 830 (p<0.001), respectively. The highest and lowest costs were materials fees and nursing care fees. No significant differences were found for five common comorbidities and postoperative complications between the two subgroups. The simultaneous groups had a shorter LOS and the differences from the staged group for TKA, THA and the TJA group were 8, 6 and 8 days, respectively. The incidence of blood transfusion is higher for simultaneous groups and the difference from the staged group for TKA, THA and TJA is 32.69%, 18% and 29.3%, respectively.

Conclusions: Our results indicate that simultaneous TKA and THA with a shorter LOS would cost fewer (costs incurred during hospitalisation) than staged TKA and THA. Complication rates were not affected by the choice for staged or simultaneous arthroplasty, but the incidence of blood transfusion was higher in the simultaneous groups.

Keywords: health economics; hip; knee; orthopaedic & trauma surgery.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

References

    1. Kamath AF, Monteiro EL, Spranger A, et al. . Simultaneous versus staged bilateral direct anterior total hip arthroplasty: are early patient-centered outcomes equivalent? Acta Orthop Belg 2016;82:497–508. - PubMed
    1. Lin AC-C, Chao E, Yang C-M, et al. . Costs of staged versus simultaneous bilateral total knee arthroplasty: a population-based study of the Taiwanese National health insurance database. J Orthop Surg Res 2014;9:59. 10.1186/s13018-014-0059-6 - DOI - PMC - PubMed
    1. Ethgen O, Bruyère O, Richy F, et al. . Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 2004;86:963–74. 10.2106/00004623-200405000-00012 - DOI - PubMed
    1. Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 2018;100:1455–60. 10.2106/JBJS.17.01617 - DOI - PubMed
    1. Kurtz SM, Ong KL, Lau E, et al. . Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021. J Bone Joint Surg Am 2014;96:624–30. 10.2106/JBJS.M.00285 - DOI - PubMed

LinkOut - more resources