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Plain-language core. Switch lenses to reveal technical or purchasing detail.
All topics
  1. What it is
  2. Who it helps
  3. Timing
  4. The procedure
  5. Patient journey
  6. Recovery supplies
  7. Implant designs
  8. Side-by-side
  9. Robotics and alignment
  10. US manufacturers
  11. What the evidence says
  12. Value analysis
  13. Questions to ask
  14. Resources
  15. Glossary
  16. References

For hospitals

Value analysis considerations

Implant price is an important part of knee replacement cost, but post-acute care, length of stay, complications and revisions drive much of the rest of the episode.

Evidence relevant to value
  • Implant cost under bundles. In one health system's bundled payment program, implant costs fell an average of $1,921 (29%) per case and were the largest source of hospital savings; total episode spending fell 20.8%.37
  • Medicare CJR. In the first year of the randomized CJR evaluation, discharge to institutional post-acute care fell 2.9 percentage points; total episode spending was not significantly different.35 Over two years, Part A spending fell $582 per episode (2.5%), driven by post-acute care, with no change in readmissions or complications.36
  • Outpatient pathways. In selected patients, outpatient arthroplasty showed similar complications and readmissions with an average cost reduction of $6,797 (hip and knee pooled).28 US mean length of stay fell from 1.87 to 1.56 days between 2019 and 2020.29
  • Complication costs. Knee PJI hospital costs are projected at $1.1 billion a year by 2030.41 Stiff knees cost 1.5 to 7.5 times more over two years.13
  • Partial knee replacement. In TOPKAT, partial knee replacement was more cost-effective than total for isolated medial arthritis, but registries show higher revision rates.26,27
  • Technology. Robotic systems improve alignment precision without clear functional benefit in RCTs; cost evidence is limited and partly industry-authored.22,43
Questions for a value analysis committee
  • What is our case mix by age, BMI and payer, and what share of cases could safely go same-day?
  • What are our 90-day readmission, infection, stiffness and revision rates, and what does each cost us?
  • What registry survivorship data does each vendor have for the specific construct we'd use (fixation, bearing, insert)?
  • Does cementless fixation change our implant price, OR time or revision risk enough to matter?
  • For robotics: what are the capital, disposable and service costs, and what utilization is needed to break even?
  • How many vendors and tray sets do we carry, and could standardization lower cost without limiting surgeons?

Switch the reading lens above to Value analysis to see hospital purchasing considerations.

Sources for this page

  1. Olsen AA, et al. The cost of stiffness after total knee arthroplasty. J Arthroplasty. 2023;38(4):638-643. doi:10.1016/j.arth.2022.10.040
  2. Abdelaziz O, et al. Comparative pain relief and functional outcomes following robotic-assisted versus conventional total knee arthroplasty: a GRADE-assessed meta-analysis with meta-regression of randomized controlled trials. J Robot Surg. 2026;20(1). doi:10.1007/s11701-026-03934-0
  3. Beard DJ, et al. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet. 2019;394(10200):746-756. doi:10.1016/S0140-6736(19)31281-4
  4. Wilson HA, et al. Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ. 2019;364:l352. doi:10.1136/bmj.l352
  5. Bemelmans YFL, et al. Safety and efficacy of outpatient hip and knee arthroplasty: a systematic review with meta-analysis. Arch Orthop Trauma Surg. 2022;142(8):1775-1791. doi:10.1007/s00402-021-03811-5
  6. Gordon AM, et al. The effect of COVID-19 on elective total knee arthroplasty utilization, patient comorbidity burden, and complications in the United States: a nationwide analysis. J Am Acad Orthop Surg. 2022;30(24):e1599-e1611. doi:10.5435/JAAOS-D-22-00193
  7. Finkelstein A, et al. Mandatory Medicare bundled payment program for lower extremity joint replacement and discharge to institutional postacute care: interim analysis of the first year of a 5-year randomized trial. JAMA. 2018;320(9):892-900. doi:10.1001/jama.2018.12346
  8. Haas DA, et al. Evaluation of economic and clinical outcomes under Centers for Medicare & Medicaid Services mandatory bundled payments for joint replacements. JAMA Intern Med. 2019;179(7):924-931. doi:10.1001/jamainternmed.2019.0480
  9. Navathe AS, et al. Cost of joint replacement using bundled payment models. JAMA Intern Med. 2017;177(2):214-222. doi:10.1001/jamainternmed.2016.8263
  10. Premkumar A, et al. Projected economic burden of periprosthetic joint infection of the hip and knee in the United States. J Arthroplasty. 2021;36(5):1484-1489.e3. doi:10.1016/j.arth.2020.12.005
  11. Sarrel K, et al. Understanding economic analysis and cost-effectiveness of CT scan-guided, 3-dimensional, robotic-arm assisted lower extremity arthroplasty: a systematic review. J Comp Eff Res. 2024;13(4):e230040. Industry co-author. doi:10.57264/cer-2023-0040

All references