The Changing World of Total Joint Arthroplasty

Abstract

The incidence of primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) has been steadily increasing over the last few decades. With the aging of the “baby boomers,” the higher rates of diagnosis and treatment of degenerative arthritis, and the growing demand for improved mobility and quality of life, the incidence of THA and TKA will continue to rise, making these procedures the most common elective surgical procedures in the coming years. Unchecked with increased utilization, healthcare costs would rise exponentially. Curbing the continuing increase in healthcare costs has led to innovative cost-containment solutions with value-based payment models. Navigating these value-based models required clinical insight, a redesign of THA and TKA programs, and administrative leadership, which optimized preoperative evaluation, created efficient clinical and surgical pathways, and ultimately reduced length of stay. These changes have evolved rapid recovery programs from inpatient to outpatient surgery for selected patients. However, the medical community, the government, and the insurers need to realize that both THA and TKA are complex procedures, which are performed on a diverse socioeconomic patient population with varying age-related comorbidities. These factors must be considered in determining the safest and appropriate setting for each patient.