Factors influencing choice of implants in total hip arthroplasty and totalknee arthroplasty - Perspectives of surgeons and patients

To determine the factors influencing surgeons' choice of implants for total hip arthroplasty (THA) and total knee arthroplasty (TKA), 650 surveys were mailed to all active members of the American Association of Hip and Knee S urgeons practicing in the United States; 364 surveys (56%) were completed a nd returned. Analysis revealed that the average number of total hip and tot al knee replacements performed by the respondents in 1997 was 81 and 97; th ere was substantial regional variation. The average number of hip implant a nd knee implant brands used by these surgeons in 1997 was 2.4 and 1.8. Anti cipated improvement in clinical results and cost of components were the mos t frequently listed reasons for changing brands. Surgeons were also queried about cost reduction programs at their particular institution. The most fr equently listed strategies for cost reduction of implants included surgeon cost-awareness programs and volume discounting. More than half of the respo ndents (53.5%) anticipate manufacturers to decrease the cost of implants in the next 2 years. Most of the respondents (93.7%) currently have the abili ty to choose a particular implant. About half (46.7%) anticipate losing som e or all control of this decision in the next 3 years. These respondents fo resee their hospitals requiring the use of a discounted implant in the futu re. An additional survey was completed by 102 consecutive patients schedule d either for primary THA (64) or primary TKA (38) at our institution. When asked about implant selection, 93.1% responded that their orthopaedic surge on should choose the prosthesis; 5.9% responded that their physician in con sultation with the patient should choose the prosthesis. When asked what sh ould be the primary determinant of implant choice, cost or quality, the ove rwhelming majority (97.1%) chose quality. A small percentage (2.9%) chose c ost and quality. No patient chose cost alone. A large number of patients (8 4.8%) responded that they would pay additional costs if their insurance com panies or health maintenance organizations refused to pay for a better but more expensive implant. Most patients realized how expensive components are , and 51% of the respondents correctly estimated the cost of an implant. Or thopaedic surgeons perceive that they are losing control of implant choice in THA and TKA. Cost of implants is one of the most significant factors inf luencing which implant is chosen. Patients (the true payers), however, over whelmingly want their surgeons to choose the implant used at surgery, and t hey want quality, not cost, to be the primary determinant of this decision.