Hip Replacement Performance and Outcomes Measurement

Hip replacement is an effective way to manage arthritis, treat fractures of this joint, or combat other conditions. Despite the fact that this is a severe medical surgery, it is prevalent in orthopedics. This report aims to examine performance indicators and outcomes measurement for hip replacement procedures, recommend best practices that can be adopted by countries, evaluate implications for both patients and organizations, and identify challenges for managing providers.

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Performance Indicators

Firstly, it is necessary to identify the similarities and differences that countries with high levels of hip replacement surgeries from these with low rates. Currently, Switzerland and Germany are the two countries that had the most significant number of hip replacement surgeries in 2015 (“Number of hip replacement surgeries,” 2019). In these statistics, the US was ranked 12 with 203,5 procedures per 100,000 individuals. Table 1 provides an assessment of performance indicators and outcomes.

In regards to accessibility, healthcare systems in all the three countries imply insurance coverage or governmental support, as well as out of pocket costs. The quality of procedures can be measured by assessing outcomes and long-term quality of life. Ackerman, Livingston, and Osborne (2015) argue that despite the increasing demand for this surgery the number of procedures performed remains low because the barriers exist on all levels. However, based on data presented in Table 1 it can be argued that patients in the US may have less accessibility due to high costs when compared to individuals in Germany and Switzerland.

Table 1. Performance indicators and outcome measures (created by the author).

Performance Indicator US Switzerland Germany
Delivery (number of surgeries per 100,000 population) 203.5 (“Number of hip replacement surgeries,” 2019) 307.7 (“Number of hip replacement surgeries,” 2019) 299.9 (“Number of hip replacement surgeries,” 2019)
Affordability (price range) From $16,500 to $33,000 (“Comprehensive care for joint replacement model,” 2019). $17,112 (Ganzer & Hoi, 2017) $8,160 (Mujica-Mota, Watson, Tarricone, & Jäger, 2017)
Accessibility rate Medium High High
Quality (ranking of the country in the world rating of health care systems) №30 (The Patient Factor, n.d.) №20 (The Patient Factor, n.d.) №25 (The Patient Factor, n.d.)


The price of the hip replacement procedure is an important factor that impacts the decision of patients to choose it as a treatment option. According to the Centers for Medicare and Medicaid Services (CMS), the average price per surgery in the US ranger from $16,500 to $33,000, which includes hospitalization and other associated costs under Medicare (“Comprehensive care for joint replacement model,” 2019).

When compared to the costs of the same procedure in Switzerland, it can be argued that the baseline price does not differ significantly. However, in the US the price range varies depending on the state and provider while Switzerland has a fixed price. According to Ganzer and Hoi (2017), the healthcare payment system in Switzerland is designed in a way where the state, compulsory health insurance, and out of pocket costs are combined when paying. The cost of hip replacement surgery in Germany is lower when compared to that in the US and Switzerland. However, based on the statistics and costing methods applied in Switzerland it can be argued that price is not the only factor that impacts decisions regarding hip replacement in the US and other countries.

Based on the information presented above several recommendations can be made that would aid future development. Firstly, it is necessary to assess the specific barriers that restrict individuals in the US and other countries from having hip replacement surgery. Next, it is essential it identify the outcomes of late procedures on the life quality of patients. Finally, specific approaches to lowering out-of-pocket costs for patients can help increase the number of performed hip replacement procedures.

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Best Practices

The data discussed above present an understanding that some people who may need hip replacement surgery chose to avoid it. This may be due to high costs or risks associated with the procedure. However, the approaches that are used by hospitals in Switzerland and Germany can be adopted to improve the accessibility and outcomes. According to Mujica-Mota et al. (2017), “without clinical guideline on the optimal timing for primary total hip replacement (THR), patients often receive the operation with delay” (p. 7161).

This can affect the outcomes of the surgery and long-term life quality of an individual. Additionally, Ackerman et al. (2015) state that for instance, many patients choose to postpone surgery, despite possible complications due to a belief that it is better to perform it at an older age. Therefore, the first best practice in successful hip replacement is early diagnosis and appropriate timing for operation.

Thus, the first recommendation is to enhance the knowledge of patients regarding possible complications and risk of adverse outcomes, which can be applied across counties through national programs and participation of providers. It can be argued that accessibility rates are high in all three countries; however, the decision-making process of people in the US is affected by risks and other factors, which impacts the overall number of surgeries performed. The second best practice is based on the study by Pellegrini, Ledford, Chang, and Cameron (2017) who argue that a crucial component that affects the outcomes of hip replacement is physical activity and a healthy diet. Thus, the next recommendation is to develop practices that would ensure patient awareness of the pre and post procedure care.

Therefore, the surgery remains to be the best practice in treating orthopedic issues in patients. The best practices were chosen based on studies by Mujica-Mota et al. (2017), Ackerman et al. (2015) and Pellegrini et al. (2017) that compare outcomes of surgeries and barriers that impact this procedure. It can be concluded that Switzerland is superior in each category because the country outnumbers others in the number of processes per 100,000 individuals. The next steps for countries include enhancement of patient’s knowledge regarding the importance of hip replacement and behavioral components that affect the outcomes.

Organizational Implications

The cost of this intervention for the organization comprises of the price for educational materials that can be provided to patients online and off-line. In general, the approach should enhance the delivery due to and the quality should be improved as well due to proper exercise and diet. Revenue for the organization will enhance, as the number of performed procedures would increase because more patients will have a hip replacement in medical establishments.

The market for the proposed strategy comprises of people aged 60 to 80 years old (Pellegrini et al., 2017). Affordability of the hip operation will remain the same as the proposed strategy will not affect the medical expenses directly and accessibility may be affected negatively by the demand. The next steps include creating a cohesive system of patient education that would enable the implementation of this strategy.

Consumer Implications

In general, hip replacement is recommended when other forms of therapy were proven not to show a positive effect. Mujica-Mota et al. (2017) state that “timely THR is cost-effective, generating large quality of life benefits for patients at a low additional cost to the SHI” (p. 7161). Thus, accessibility and affordability will be affected by the proposed strategy. The delivery process will not be altered except for increased attention towards pre and post operation care, which should increase the number of successful procedures and affect the quality. Affordability and accessibility will remain the same for patients because the price for hip replacement operations will not be changed. The next step is to create a communication system that would help health care providers communicate the ideas described in this report.

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Provider Management

Based on this proposal, several challenges connected to the management of fee-for-fee and risk-based contracting plan. Within a fee for fee system, insurers pay for each procedure separately; thus the quantity is a significant factor that impacts the revenue. This is a challenge because, in the case of hip replacement, the patient has to pay for the hospital stay, operation, and medication regardless of the outcome, which is the primary challenge.

Risk-based contracting is a more advanced system that allows patients to pay for the result of their treatment, therefore emphasizing the quality. For instance, in case a patient needs revising surgery, he or she would not have to pay for it. The challenge is in accounting for the specific factors that depend on a provider. The next step within the proposed strategy is to create a contract based payment plan that would highlight the importance of quality care.


Overall, hip replacement surgery is a popular orthopedic procedure that has the best performance indicators in Germany and Switzerland. In general, the primary signs for cost, affordability, quality, and accessibility do not differ across the two countries and the US. However, barriers such as fear of risks affect the decision to postpone the operation, which can lead to complications. Thus, the proposal offers a strategy that would help raise awareness about the issue and help individuals choose hip replacement surgery.


Ackerman, I., Livingston, J., & Osborne, R. (2015). Personal perspectives on enablers and barriers to accessing care for hip and knee osteoarthritis. Physical Therapy, 96(1), 26-36. Web.

Comprehensive care for joint replacement model. (2019). Web.

Ganzer, T. & Hoi, G. (2017). Do American and Swiss patients get what they pay for? Web.

Mujica-Mota, R. E., Watson, L. K., Tarricone, R., & Jäger, M. (2017). Cost-effectiveness of timely versus delayed primary total hip replacement in Germany: A social health insurance perspective. Orthopedic Reviews, 9(3), 7161. Web.

Number of hip replacement surgeries in OECD-countries as of 2015 (per 100,000 population). (2019). Web.

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The Patient Factor. (n.d.). World Health Organization’s ranking of the world’s health systems. Web.

Pellegrini, C. A., Ledford, G., Chang, R. W., & Cameron, K. A. (2017). Understanding barriers and facilitators to healthy eating and physical activity from patients either before and after knee arthroplasty. Disability and Rehabilitation, 40(17), 2004-2010. Web.

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