# Measuring Short-Term Outcomes Following Primary Total Hip Arthroplasty: A Value-Based Healthcare Approach

## TL;DR

This study evaluates the value of total hip arthroplasty using patient outcomes and costs, finding that most patients achieve satisfactory results but certain factors lower the value.

## Contribution

A novel methodology is proposed to assess the value of total hip arthroplasty using patient-reported outcomes and direct costs.

## Key findings

- 82% of patients had a satisfactory THA value (≥1.0).
- Female sex, higher preoperative PROMs, and certain implant types were associated with lower THA value.

## Abstract

Background/Objectives: Total hip arthroplasty (THA) is a highly effective treatment for end-stage hip disease, but the increasing volume of procedures demands a focus on value-based healthcare (VBHC) to ensure optimal outcomes. This study proposes a novel approach to evaluate the value delivered by THA using direct costs and patient-reported outcome measures (PROMs). Methods: This retrospective cohort study included patients undergoing primary THA for unilateral osteoarthritis at two hospitals between 2018 and 2021. PROMs specific to hip osteoarthritis were assessed preoperatively and in the second postoperative year. The delivered quality was calculated using PROM results in comparison with the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds. The associated cost was defined as direct THA expenses in comparison with the median direct costs of the cohort series, and the value was calculated as the ratio of quality over cost. A multivariable linear regression was performed to identify the factors associated with the THA value. Results: Among 224 patients (70 ± 10 years, 46% males), THA was of satisfactory value (≥1.0) for 82%. The THA value was lower for patients of female sex (β −0.27, p = 0.047), with higher preoperative PROMs (β −0.36, p < 0.001), previous contralateral THA (β −0.36, p = 0.049), or ipsilateral hip surgery (β −1.41, p < 0.001) with custom (β −0.76, p = 0.011) or fully cemented (β −0.83, p = 0.021) implants. Conclusions: The proposed methodology effectively assessed the THA value, revealing satisfactory outcomes for most patients but also identifying areas for improvement. These findings emphasize the need for risk-adjusted VBHC models to enhance equity and efficiency in arthroplasty care.