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The Journal of Bone and Joint Surgery (American). 2004;86:2435-2439
© 2004 The Journal of Bone and Joint Surgery, Inc.

In-Hospital Cost of Total Hip Arthroplasty in Canada and the United States

John Antoniou, MD, PhD1, Paul A. Martineau, MD1, Kristian B. Filion, BSc2, Seema Haider, MSc3, David J. Zukor, MD1, Olga L. Huk, MD1, Louise Pilote, MD, MPH2 and Mark J. Eisenberg, MD, MPH2

1 Division of Orthopaedic Surgery, Jewish General Hospital, McGill University Montreal, 3755 Cote Ste. Catherine Road, Suite E-003, Montreal, QC H3T 1E2, Canada
2 Divisions of Cardiology (K.B.F and M.J.E) and Epidemiology (L.P.), Montreal General Hospital, McGill University, 3755 Cote Ste. Catherine Road, Suite A-118, Montreal, QC H3T 1E2, Canada
3 Central Research Division, Pfizer Inc., 558 Eastern Point Road, Groton, CT 06340

Investigation performed at Jewish General Hospital and Montreal General Hospital, McGill University, Montreal, Quebec, Canada

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Pfizer. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: There is little information comparing the costs of specific surgical procedures performed in Canada and those done in the United States. The objective of this study was to compare the in-hospital costs associated with primary total hip arthroplasty performed in the two countries.

Methods: In-hospital costs of 1679 consecutive patients (940 Canadian and 739 American patients) who underwent total hip arthroplasty were extracted from three Canadian and three United States teaching hospitals between 1997 and 2001. Participating hospitals used the same cost accounting system to provide per-patient demographic, clinical, and cost data. Canadian dollar costs were converted to United States dollar costs with use of purchasing power parities.

Results: The baseline clinical characteristics of patients undergoing total hip arthroplasty in Canada and the United States were similar. The American patients were a mean of 4.6 years older than the Canadian patients (mean [and standard deviation], 67.8 ± 12.4 years compared with 63.2 ± 14.9 years). The median cost for the primary arthroplasty was $6080 (mean [and standard error of the mean], $6766 ± $119) at the three Canadian hospitals and $12,846 (mean, $13,339 ± $131) at the United States hospitals (p < 0.0001). The mean length of stay (and standard deviation) was 7.2 ± 4.7 days for the Canadian patients and 4.2 ± 2.0 days for the American patients. Implants at one hospital in the United States were found to be four times more costly than those in a Canadian hospital.

Conclusions: Higher in-hospital costs were found for the American hospitals despite the fact that they had a significantly shorter patient length of stay compared with Canadian centers (p < 0.0001). Canadian hospitals should follow the lead of their counterparts in the United States and implement strategies to decrease the length of stay in the hospital, while institutions in the United States should revisit their ability to better manage the costs related to a primary total hip arthroplasty, particularly by controlling unit costs.

Level of Evidence: Economic and decision analysis, Level II-1 (clinically sensible costs and alternatives; values obtained from limited studies; multiway sensitivity analyses). See Instructions to Authors for a complete description of levels of evidence.


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