Press Release

Embargoed Until Contact

May 09 , 2012

Sue Ducat
Director of Communications
(301) 841-9962


From Health Affairs


Wide Variations in Knee Replacement Surgery Fees and Care


Bethesda, MD -- Knee osteoarthritis is a common ailment—and treatment is expensive: in 2008 total knee replacement inpatient costs in the United States exceeded $9 billion—the highest among the ten procedures for which demand is growing the fastest. A new study, released today as a Web First by Health Affairs, compared operating times, hospital lengths-of-stay, discharge dispositions, and in-hospital complication rates of five organizations, all members of the High Value Healthcare Collaborative. The study authors identified three key findings:


  • The health system with the lowest in-hospital complication rate had brought together patients with a multispecialty team prior to the surgery, including members from anesthesiology and internal medicine to co-manage medically complex patients.

  • The fastest operating times (and shortest patient stays) were at a hospital where knee replacement cases were staffed by a team of anesthesia doctors, scrub techs, and nurses specializing in arthroplasty.

  • The health system that involved patients prior to surgery in their discharge planning process (and managed patient expectations about disposition after hospitalization) resulted in shorter hospitalizations.


A Collaborative Of Leading Health Systems Finds Wide Variations In Total Knee Replacement Delivery And Takes Steps To Improve Value


By Ivan M. Tomek, Allison L. Sabel, Mark I. Froimson, George Muschler, David S. Jevsevar, Karl M. Koenig, David G. Lewallen, James M. Naessens, Lucy A. Savitz, James L. Westrich, William B. Weeks, and James N. Weinstein


Tomek, Koenig, and Weinstein are affiliated with the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire; Sabel is with the University of Colorado in Denver; Froimson is president and CEO of Euclid Hospital in Euclid, Ohio; Muschler is affiliated with the Cleveland Clinic; Jevsevar and Savitz are with Intermountain Healthcare in Utah; Lewallen and Naessens are affiliated with the Mayo Clinic in Rochester, Minnesota; and Westrich and Weeks are with the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, New Hampshire.


The goal of the study was to identify opportunities to improve health care value by increasing the quality and reducing the cost of the procedure. The data consisted of 10,910 single knee replacement surgeries in 2008 and 2009 from the five health care delivery systems (Cleveland Clinic, Denver Health, Dartmouth Institute for Health Policy and Clinical Practice, Intermountain Healthcare, and Mayo Clinic). Additionally, the study found that longer hospital stays were the result of surgeries done later in the week and to older and sicker patients. Based on these results, the consortium recommends more coordinated management for medically complex patients, more use of specialized staff, and a process to improve the management of patient expectations. These innovations are being tried by the consortium’s members to evaluate whether they increase health care value.

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically and health policy briefs published twice monthly at You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download weekly Narrative Matters podcasts on iTunes.

The full text of each Health Affairs Web First paper is available free of charge to all Web-site visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund.