Abstract
Aims
To establish the cost of primary hip (THR) and knee (TKR) arthroplasty in an elective orthopaedic centre in the UK and to compare it with current government reimbursement to NHS hospitals and the costs in North America.
Methods
In 2004 an elective orthopaedic centre was set up in South West London which performs mainly primary lower limb arthroplasty. We used a retrospective analysis of financial statements from September 2004-June 2005 inclusive to establish operative costs (including implant), perioperative costs and post-operative costs until discharge.
Results
A total of 691 THRs and 897 TKRs were performed during this period accounting for 76% of the workload. Average post-operative stay was 6.5 days for TKRs and 5.7 for THRs. Average cost for a TKR was £6651 and for a THR £5990. Costs are favourable compared with our American colleagues and similar to our Canadian colleagues. Reimbursement in the NHS was set up in 2003-4 by the DH in the form of national tariffs. Our costs are similar to these reimbursements. We question the ability of general NHS hospitals in the UK to perform at these levels and prices for three reasons. Firstly, our high volume of joint replacement activity has enabled us to negotiate the most favourable implant prices in the UK. Secondly, length of stay in our unit is approximately 60% of national average. Thirdly, our unit is run without many of the infrastructure costs of a general hospital as well as the cost incurred by training junior staff and research and development.
Conclusion
Our elective-only orthopaedic centre provides a cost effective way of performing primary arthroplasty surgery while maintaining high standards of care and twenty-four hour intensive care cover. We believe this cost effectiveness may be unachievable in general NHS hospitals in the UK.
