IMPLANT STANDARDIZATION FOR TOTAL HIP-ARTHROPLASTY - AN IMPLANT SELECTION AND A COST REDUCTION PROGRAM

Total hip arthroplasty (THA) has been targeted by the United States fe deral government for cost control because of its high cost and rising incidence in the aging population. The hospital cost for THA during th e 1980s was controlled by utilization review and a reduction in the vo lume of services delivered for each THA. The single largest increase i n the cost of THA during the 1980s was the cost of hip implants. The L ahey Clinic Hip Implant Standardization Program was developed to provi de objective guidelines far hip implant selection. These guidelines ar e based on the demands a patient is expected to place on his or her hi p prosthesis. Because not every patient requires an expensive high-dem and hip prosthesis, the standardization program also has the potential to reduce the hospital cost for hip implants without compromising pat ient care. Patients are assigned to four demand categories based on fi ve objective criteria: age, weight, expected activity, general health, and bone stock. Selection of the prosthesis in each of the four deman d categories is intended to match the implant's capacity with expected patient demand. The standardization program was retrospectively appli ed to 103 THAs performed during 1991. Analysis of variance demonstrate d that patient variables and demand categories were statistically sign ificant groupings. The cost of hip implants would have been reduced by 25.7% with the Lahey Clinic Hip Implant Standardization Program. A pr ospective outcome study is required to determine the long-term validit y of this standardization program.