JOA - 2026-09-01 - Journal Article; Comparative Study
There Is No Difference in Outpatient Costs Within One Year Post-Total Hip Arthroplasty when Comparing Surgical Approach.
Barton KI, Kooner P, Petis SM, Somerville LE, Marsh JD, Howard JL, Lanting BA, Vasarhelyi EM
Topics
Key Takeaway
Total outpatient costs at one year did not differ significantly across anterior ($1,321 CDN), posterior ($1,095 CDN), and lateral ($1,153 CDN) THA approaches (P=0.114), though anterior approach generated higher allied health costs ($361 vs $207 posterior, P=0.028).
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Summary
This prospective microcosting study asked whether surgical approach influences outpatient resource utilization and patient expenses in the year following primary THA in a Canadian health system. Patients self-reported costs via diary across anterior, posterior, and lateral cohorts; groups were not randomized. Total outpatient costs were statistically equivalent across approaches, but anterior approach patients incurred significantly higher allied health service costs and more nursing care visits than posterior or lateral groups.
Key Limitation
Non-randomized allocation with small, unequal group sizes limits causal inference and statistical power to detect clinically meaningful cost differences in subgroup analyses.
Original Abstract
BACKGROUND
Total hip arthroplasty (THA) continues to be a substantial financial burden to the Canadian health care system. The purpose of this study was to determine the impact of surgical approach on the associated outpatient cost of THA.
METHODS
Patients who underwent a THA via an anterior, posterior, or lateral approach were recruited (not randomized). All patients prospectively completed a cost diary (self-reported use of allied health services, investigations, clinic visits, patient expenses, and number of employment days lost to THA) to estimate total resource use and patient expenses incurred after discharge. Group comparisons were performed using Pearson's Chi-squares and one-way analyses of variance; significance was accepted at P ≤ 0.05.
RESULTS
A prospective, microcosting analysis was performed on 104 patients undergoing a THA through either an anterior (n = 37), posterior (n = 32), or lateral (n = 35) approach for one year postoperatively. The overall costs of outpatient resources and expenses were comparable between anterior ($1,321.00 CDN), posterior ($1,094.92 CDN), and lateral ($1,153.18 CDN) approaches (P = 0.114). When the overall costs were stratified by specific expenses, the costs of allied health services were significantly higher in the anterior group ($361.32 CDN; 95% confidence interval, 257.58 to 465.07) than the posterior group ($206.50 CDN; 95% confidence interval, 124.50 to 288.50, P = 0.028). This correlated with a higher number of average nursing care visits for the anterior group than both the posterior and lateral groups (P = 0.001). There were no differences in costs of clinic visits, investigations, or number of employment days lost to THA.
CONCLUSIONS
Cost analysis on the effect of surgical approach for THA in outpatient resources and expenses resulted in comparable overall costs between the anterior, posterior, and lateral approaches. Future directions include capturing long-term effectiveness measures to perform a cost-effectiveness analysis from a societal perspective.