These authors reviewed 361 shoulder arthroplasties performed at their facility in an attempt to identify the patient and procedure characteristics associated with costs.
19% had revision arthroplasty procedures, 32% had anatomic total shoulder arthroplasties, and 66% had reverse total shoulder arthroplasties (RTSAs).
Of the total costs, 58% were operative supply costs, including implants.
Factors associated with increased operative costs included younger age (P . .002), use of an RTSA
(P < .001), use of a bone graft (P < .001) and implant brand.
Factors associated with increased operative costs included younger age (P . .002), use of an RTSA
(P < .001), use of a bone graft (P < .001) and implant brand.
Comment: As the authors point out there are some modifiable factors that can have a profound effect on the cost of arthroplasty.
First, the actual implant costs are hidden from view. Each hospital confidentially negotiates the actual dollar amounts paid by the medical center for the total joint implants. We are aware that some medical centers will only accept implant prices that are 15% of the median price in the U.S. Thus there is an "invisible" but huge disparity among hospital payments for shoulder implants. If the prices were known and pegged at this low value, it is evident that the total U.S. costs would be dramatically reduced.
Secondly, there is a trend toward the use of the reverse total shoulder even in cases well suited for an anatomic shoulder arthroplasty. The average selling price for a Reverse Total Shoulder is almost 50% higher than the anatomic total shoulder (See the data below from Orthopaedic Network News, Volume 30, Number 1, January 2019:
We believe that implant pricing should be public. If vendors want to provide discounts for high volume centers, that should be public as well.
We also believe that a reverse total shoulder is usually not necessary for osteoarthritic shoulders with intact rotator cuffs.
These two steps could go a long way to reducing the implant costs for shoulder arthroplasty, which comprise the major component of the overall costs of these procedures.
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Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
Use the "Search" box to the right to find other topics of interest to you.
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