Defining Value in Hip and Knee Arthroplasty in the United States Alison K. Klika, MS Carlos A. Higuera, MD Anas Saleh, MD Preetesh Patel, MD Juan Suarez, MD Wael K. Barsoum, MD Investigation performed at the Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio COPYRIGHT © 2014 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED » The quality of health care is influenced by, and is defined differently according to, the perspectives of the various stakeholders (i.e., surgeons, patients, hospitals, the United States government, and private payers). » Reconciling these differences is a challenge to hip and knee arthroplasty surgeons and is important for the future of health care in terms of value-based purchasing, pay for performance, and furthering innovation in new joint replacement products and technologies. » Sound, well-conducted cost-benefit and other economic analyses of hip and knee arthroplasty-related products and procedures are critical elements of value-based orthopaedic care and are facilitated by the recent trend toward greater transparency regarding health-care costs and charges. V alue-based health care has become a topic of intense debate in discussions on health-care reform. With re- cent governmental interventions, under- standing the role of value in orthopaedic surgery is an absolute requirement. It is critical that we properly define the elements needed to measure value, which is defined as quality over cost, or health outcomes achieved per dollar spent 1 . It is the nu- merator in the value equation—i.e., quality (health outcomes)—that presents the most important challenge as there are many ways to define and measure quality. Analogous to economic cost analyses, there are varying points of view regarding the definition of quality and, therefore, value. Different stakeholders, including patients, surgeons, hospitals, the government, and private payers, have different opinions and prior- ities when it comes to what is important in determining the outcome of a procedure or treatment (Fig. 1). It is this shared common goal of value that unites stakeholders, but varying perspectives and agendas create a divide in terms of defining quality. Total hip arthroplasty and total knee arthroplasty are two of the most successful operations available in terms of improving quality of life 2,3 . Total hip arthroplasty has been reported to have a nearly 80% rate of implant survival at more than thirty years postoperatively 4 , and total knee ar- throplasty has been reported to have a 96% rate of implant survival at fifteen to twenty years 5,6 . The calculated quality of well year (QWY) is $5572 for primary total hip arthroplasty and $10,775 for revision total hip arthroplasty, comparable with those reported for other procedures such as gastric bypass 7 . While total hip arthroplasty and total knee arthroplasty are recognized as beneficial and cost-effective treatments for patients who have joint disease, the scrutiny with which these procedures are Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article. | JBJS REVIEWS 2014;2(7):e1 · http://dx.doi.org/10.2106/JBJS.RVW.M.00073 1