Cost Analysis of Sending Routine Pathology Specimens following Total Joint Arthroplasty in the Age of Bundled Payments

Surg Technol Int. 2017 Oct 12:31:182-188.


Bundled payment plans are being developed as a means to curb healthcare spending. Routine histology following total hip arthroplasties (THA) and total knee arthroplasties (TKA) is standard practice at many institutions. Recently, the value of this practice has been questioned as histologic diagnoses in THA and TKA rarely differ from the clinical diagnoses. The goal of this study is to identify discrepant and discordant diagnoses following THA and TKA at an academic medical center and to calculate the cost-saving potential in the setting of a bundled payment plan. A retrospective chart review was conducted on 1,213 primary THA and TKA performed by two orthopaedic surgeons from 2012 to 2014. The clinical and histologic diagnoses were compared and classified as concordant, discrepant, or discordant. Cost information was obtained from the institutional billing office. One thousand one hundred and sixty-six THA and TKA were analyzed in the final cohort. Nineteen (1.6%) diagnoses were classified as discrepant while none were discordant. The cost of histologic examination per specimen was estimated to be $48.56. The total cost of all arthroplasties was $14,999,512.46, of which histologic examination made up 0.31% of the total cost. The results of this study corroborate the results of previous studies and support the proposition that routine histologic examination is not cost-effective. The cost incurred to perform histologic examination will become a cost deduction from future bundled payments. The practice of sending routine histologic specimens following TJA should be decided upon by the operating orthopaedic surgeon.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Knee* / economics
  • Arthroplasty, Replacement, Knee* / statistics & numerical data
  • Costs and Cost Analysis*
  • Female
  • Health Care Costs*
  • Histology* / economics
  • Histology* / statistics & numerical data
  • Humans
  • Knee Joint / surgery*
  • Male
  • Middle Aged
  • Osteoarthritis / diagnosis
  • Osteoarthritis / pathology
  • Osteoarthritis / surgery
  • Retrospective Studies
  • Young Adult