Implant Prices and Physician Reimbursement Have Declined Significantly in Total Joint Arthroplasty, Outpacing More Modest Reductions in Total Costs and Hospital Payments.

Abstract

Understanding implant price trends is critical amid growing demand for total joint arthroplasty (TJA) and increasing cost containment pressures. Previous studies have documented trends in costs, reimbursements, and volume for TJA. However, the relationship between implant prices, hospital and physician reimbursement, and patient financial burden remains poorly defined. This study evaluated inflation-adjusted implant pricing trends in TJA and their alignment with physician and hospital reimbursement and patient out-of-pocket (OOP) costs. Implant prices for primary total knee arthroplasty (TKA), total hip arthroplasty (THA), revision TKA (rTKA), and revision THA (rTHA) from 2009 to 2021 were obtained from a large publicly available implant registry. Cost, reimbursement, and patient OOP spending data were sourced from a commercial insurance claims database. There were 629,651 total procedures analyzed. All costs, reimbursements, and prices were adjusted for inflation. Trends were analyzed using linear regressions. The average price for TKA implants was $5,899, $6,776 for THA, $11,576 for rTKA, and $7,419 for rTHA. Between 2009 and 2021, implant prices declined markedly for TKA (-38%), THA (-37%), and rTHA (-28%) and remained stable for rTKA (+8%). Overall costs and hospital reimbursement remained stable or modestly decreased, while physician reimbursement declined markedly across all procedures (-26 to -32%). Patient OOP spending remained relatively unchanged across all procedures. Although implant prices have decreased over time, the financial benefit has not been realized by patients or surgeons. To our knowledge, this is the first study contextualizing implant cost trends alongside total costs, reimbursement, and OOP patient costs in TJA, and it highlights persistent gaps in cost transparency. In an era of increasing TJA volumes and mounting cost control pressures, these findings underscore the need for surgeon awareness of implant costs, which is particularly relevant in implementing future changes to clinical practice, payment, and policies.