Surgical Approaches in Total Hip Arthroplasty Cost Per Case Analysis: A Retrospective, Matched, Micro-costing Analysis in a Socialised Healthcare System

Hip Int. 2020 Jul;30(4):391-397. doi: 10.1177/1120700019839039. Epub 2019 Apr 2.


Background: Total hip arthroplasty (THA) offers an effective method of pain relief and restoration of function for patients with end-stage arthritis. The anterior approach (AA) claims to benefit patients with decreased pain, increased mobilisation and decreasing length of hospital stay (LOS). In a socialised healthcare platform we questioned whether the AA, compared to posterior (PA) and lateral (LA) approaches, can decrease the cost burden.

Methods: Using a retrospective matched cohort study, we matched 69 AA patients to 69 LA and 69 PA patients for age (p = 0.99), gender (p = 0.99) and number of pre-surgical risk factors (p = 0.99). First, we used the Resource Intensity Weights (RIW) using the Health Services agreed on method of calculating cost. Secondly, micro-costing analysis was performed using the financial services data for each patient's hospital stay.

Results: Using the RIW based cost analysis and 2-day reduction (95% CI 1.8-2.4) in LOS, the AA offers an estimated savings per case of $4099 (p < 0.001) compared to the LA and PA. Using micro-costing analysis, we found a total saving of $1858.00 per case (95% CI 1391-2324) when comparing the AA to the PA and LA. There was a statistically significant cost savings using every category: Net Direct Salary ($901.00, p < 0.001), Net Drug ($8.00, p = 0.003), Patient Supply ($454.00, p = 0.001), Patient Drug ($15.00, p = 0.008), Indirect Cost ($385.00, p < 0.001), Patient Care Administration ($106.00, p < 0.001). Furthermore, the AA saved 142 minutes of in-hospital rehabilitation time.

Conclusion: The AA THA provides statistically significant reductions in cost compared to PA and LA while releasing rehabilitation resources.

Keywords: Arthroplasty; cost analysis; hip; retrospective; total.

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip / economics*
  • Arthroplasty, Replacement, Hip / methods
  • Costs and Cost Analysis
  • Female
  • Humans
  • Length of Stay / economics*
  • Male
  • Middle Aged
  • Osteoarthritis, Hip / economics*
  • Osteoarthritis, Hip / surgery*
  • Retrospective Studies
  • Risk Factors
  • State Medicine / economics*
  • Treatment Outcome
  • United Kingdom