JOA - 2026-06-01 - Journal Article
Total Knee Arthroplasty Out-of-Pocket Costs on the Rise: A Nationwide Analysis of Financial Burden and Regional Disparities.
Singh P, Marrache M, Kim AH, Williams S, Hegde V, Khanuja HS
Topics
Key Takeaway
Mean TKA out-of-pocket costs reached $2,472 from 2015–2020, with a 3.8-fold geographic range (Hawaii $1,024 to Alaska $3,910) and ambulatory surgical centers consistently generating higher OOPCs than outpatient hospital settings.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study analyzed temporal trends and geographic, setting-based, and insurance-type variation in TKA out-of-pocket costs (OOPCs) using a national database from 2015–2020. OOPCs increased significantly over the study period (mean $2,472 ± $1,990), with the West region highest ($2,562) and Northeast lowest ($2,035), and high-deductible health plans generating the greatest patient financial burden. Ambulatory surgical centers produced higher OOPCs than outpatient hospital settings across all procedures (P<0.01), a counterintuitive finding given ASCs' lower facility fees.
Key Limitation
The database lacks clinical variables (BMI, comorbidities, implant type, bilateral status), preventing risk adjustment and making it impossible to determine whether OOPC differences across settings reflect case-mix selection rather than true setting-driven cost variation.
Original Abstract
BACKGROUND
Out-of-pocket costs (OOPCs) for arthroplasty procedures represent a growing financial burden for patients. There is limited available data on trends and the impact of geographical location. The purpose of this study was to analyze temporal trends and to assess differences in OOPCs by surgical setting, insurance plan type, and geography associated with total knee arthroplasty (TKA) in the United States.
METHODS
A retrospective analysis of patients who underwent TKA from 2015 to 2020 was conducted using a large national database. Patients were identified using Current Procedural Terminology codes, and OOPCs were calculated as the sum of deductibles, copayments, and coinsurance. All financial data were adjusted to 2020 U S. dollar equivalents. The OOPCs were analyzed over time and by geographic location, along with the impact of insurance type and surgical setting on OOPCs. In total, 34,942 patients who underwent TKA were identified for analysis.
RESULTS
The OOPCs significantly increased from 2015 to 2020 (P < 0.05), with a mean OOPC of $2,472 + 1,990. The TKA OOPCs varied considerably by geography, with the highest costs in Alaska ($3,910) and the lowest costs in Hawaii ($1,024) (P < 0.001). Regionally, the West had the highest OOPCs ($2,562), while the Northeast had the lowest ($2,035) (P < 0.001). Ambulatory surgical centers incurred higher OOPCs than outpatient hospital settings for all procedures (P < 0.01). High-deductible health plans had the highest, and point-of-service with capitation health plans had the lowest OOPCs among all insurance types.
CONCLUSIONS
The OOPCs for TKA procedures have increased over time. With geography, surgical setting, and insurance type affecting OOPCs, understanding how these factors impact costs will allow physicians and policymakers to improve resource allocation and develop cost-saving strategies to minimize patient financial burdens associated with arthroplasty procedures.
LEVEL OF EVIDENCE
III.