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Orthopedic Research and Patient Outcomes

Stanley Mendenhall, MA, MS
JAMA. 1990;264(6):694. doi:10.1001/jama.1990.03450060040018.
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To the Editor.—  Paul Cotton's1 perspective on the state of research in the orthopedic industry is both timely and relevant. One element not addressed in his article was the impact of implant technology on hospital cost. Our research indicates that 67% of patients who receive hip or knee implants are Medicare beneficiaries. Total hip, partial hip, and knee implants are all classified as DRG 209, Major Joint Implant, with a hospital payment of about $7000 for a rural hospital and about $8000 for an urban hospital. The payment is supposed to cover all hospital costs, including nursing, laboratory, operating room, and cost of the prosthesis. The cost of the prosthesis alone can be as much as $4000 for a complete knee system; a total hip prosthesis may cost nearly $4500.Dr Sledge and others rightly question whether newer technology affects patient outcomes; does an additional $2000 for a prosthesis


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