Total Joint Replacement, Bundled Payments, Patient Risk Factors to Success

Total Joint Replacement, Bundled Payments, Patient Risk Factors to Success

By William P Barrett, MD

In the February issue of The Journal of Arthroplasty, there were several articles examining the influence of various medical comorbidities and the risk for complication after hip and knee replacement. This is a very “hot topic” as the Centers for Medicare and Medicaid are moving to bundled payments where physicians and hospitals will be at risk for complications and readmission after joint replacement. This will increase the need for optimization of patients prior to surgery to minimize readmissions and complications. This is good for the cost of health care and for patients undergoing these elective procedures.

In the first article, “Calculating the Costs and Risk of Comorbidities in Total Joint Arthroplasty in the United States,” author Joshua Hustedt and coauthors outline the most common preop comorbidities, which include hypertension in 66% of patients reviewed, diabetes in 20%, obesity in 19%, and anemia and 16%. These patients were selected from a large Medicare database, representing a national estimate of over 4 million patients. What the authors found that medical comorbidities increased with increasing age, all of these comorbidities increase the cost of the episode of care, and the most costly comorbidities were issues related to blood clotting, congestive heart failure, and chronic failure.

In an article entitled “The Impact of Metabolic Syndrome on 30-Day Complications Following Joint Arthroplasty,” author Adam Edelstein and his coauthors reviewed the affect of metabolic syndrome, which is a constellation of findings related to obesity and include a BMI greater than 30, truncal obesity, diabetes, and elevated cholesterol, all contribute to increase complications following surgery. In a review of over 100,000 patients, they found obese patients with metabolic syndrome had an increased risk of complication, wound problems and readmission following joint replacement, and the greater degree of obesity was associated with a higher rate of complication.

As evolving data shows, it is incumbent upon patients to take control of their health and try and minimize their risk of complication. As Michael Greger, MD, in his book How Not to Die, outlines the key to a healthier life begins with a more plant-based diet and avoiding many of the things that contribute to obesity and medical comorbidities.

About The Author

William Barrett, MD is a fellowship trained orthopedic surgeon who specializes in primary and revision hip and knee replacement. He performs over 500 hip and knee replacement procedures each year. He is actively involved in clinical research on Anterior Approach Total Hip Replacement (THA), Alternative Bearings for THA, Less Invasive Approaches to joint replacement and use of computerized vs. custom cutting guides for knee replacement. As a nationally recognized joint replacement surgeon, he lectures globally on hip and knee replacement topics. He is active in the American Academy of Orthopaedic Surgeons Continuing Medical Education programs. He is a board examiner for the American Board of Orthopaedic Surgery.


  1. Robert

    I have a partial meniscus, like a wedge, left part of, right knee, is bone on bone, the other side of knee has the rest of my miniscus I had my first shot and 90 days of pain pills, for about two months now. I am a good candidate for PKR?

    1. Valley Communications

      Hi Robert,

      I sent your question to Dr. Barrett. He says “Many factors involved in deciding if a patient is a candidate for partial knee. They include patients symptoms, exam and x-rays. About 10% of patients are candidates for partial knee.”

      Thanks for reading the blog!
      -Tara, Valley Medical Center Marketing & Communications

  2. Donna Butler

    I am debating having a double knee replacements. Worried about recovery. How do I make best decision on whether I should do 1 knee or both

    1. Valley Communications

      Multiple factors influence the decision to do both knees at the same time. These include your age, overall health, and fitness level. You should discuss these with your surgeon.

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