The most exciting opportunities for total joint replacement surgeons today


Five total joint replacement surgeons weigh in on the best opportunities for TJR specialists in the industry.

Ask TJR surgeons is a weekly series of questions posed to orthopedic surgeons around the country about clinical, business and policy issues affecting orthopedic care. We invite all orthopedic surgeon and specialist responses.

Next week's question: In what ways will outpatient TJR evolve in the next five to 10 years?

Please send responses to Anuja Vaidya at by Thursday, June 29, at 5 p.m. CST.


Question: What are some of the biggest opportunities for TJR surgeons in today's healthcare landscape?


G. Daxton Steele, MD. Total Joint Replacement Surgeon at Andrews Institute for Orthopaedics & Sports Medicine (Gulf Breeze, Fla.): Currently insurance companies and the government are trying to reduce cost associated with total joint replacements and we as physicians stand at the forefront to both assist these agencies with this endeavor and to help our patients benefit from these programs by reducing extraneous measures that aren't really necessary for the success of a total joint replacement.


Andrew M. Star, MD. Joint Surgeon at Rothman Institute (Philadelphia): Several items come to mind. Firstly, we continue to seek better results for total knee patients. The patient satisfaction with total hips has been superior to total knees for many years. Whether this requires a different type of knee implant or a different way of implantation remains an open question. So far the industry has focused on better implantation techniques, such as robots, and different implants, such as bicruciate sparing. Surgeons who adopt the right technology or who become involved in improving the process will be successful.


New payment options such as bundled payments reward surgeons and healthcare systems that are efficient and cost-effective. Becoming an agent of change to make the right decisions for your patients is a tremendous opportunity. Many surgeons (and patients) are afraid of the changes that occur with value-based utilization of services, but choosing the most effective means of care produces better outcomes for patients and can be profitable for surgeons and healthcare systems.


Finally, consolidation among healthcare provides many new opportunities for physicians who are interested in being a part of an administrative team. As specialists form larger groups or become part of larger multispecialty organizations, there is tremendous need for physicians to be "on the inside" making the right decisions for their colleagues and their patients. Traditionally surgeons have not been excited by administrative roles, but larger healthcare organizations have more sophisticated staff and financial resources that allow those organizations to have greater impact on the provision of services and be rewarded for it!


Joe Assini, MD. Joint Specialist at Orthopedic Physicians of Colorado, Swedish Medical Center (Denver): From a patient perspective, one challenge is also a major opportunity; providing patients with a joint replacement that allows them to return to their full activities. In the past joint replacements were used in an older, more sedentary population. This is not the case today. Many of my patients are very active people who have simply 'worn out' their joints due to their active lifestyle. They come to us looking to continue that same lifestyle after their replacements. Our goal is to get patients back to virtually all the activities they enjoy after surgery. For the majority of our patients this goal is realized within the first 12 weeks. This stems from an improvement in the implant technology and our use of modern, minimally invasive techniques that maximize recovery potential.   

The biggest challenge from a system perspective is working within the ever-changing insurance landscape. Hopefully providers, insurers and patients will use this fluctuation to identify new care delivery models that maximize patient outcomes while improving affordability and efficiency in the system as a whole.


Henry Finn, MD. Director the Chicago Center for Orthopedics at Weiss Memorial Hospital: There will be many opportunities for TJR surgeons to grow their practices. Because total joint replacement surgery is so cost-effective with successful outcomes and quickly returns patients to a good quality of life, there will always be a need for this specialty of surgeons, especially with the exponential growth of this procedure with the aging population.

The caveat will be insurance payment. With more people in need of joint replacement, the number of procedures done might be limited to extreme cases. Due to inappropriately low government reimbursements and a high demand for the surgery, surgeons might see an opportunity to develop a fee-for-service practice.


Jeffrey C. Davis, MD. Orthopedic Surgeon at Andrews Sports Medicine & Orthopaedic Center (Birmingham, Ala.): The need for joint replacement surgery will continue to grow as the population ages, stays active longer and younger people opt for surgery rather than living with arthritis. As the volume of primary surgery increases, the need for revision surgeries will also increase. TJR surgeons should be the leaders in data collection to improve outcomes and decrease the need for revision surgeries. Standardizing care, following best practices and determining what those are will be important for TJR surgeons going forward.

TJR surgeons need to continue to work to show value and quality for payers and the public. This will become increasingly important because of the volume and expense associated with TJR in order to have adequate reimbursement for performing these surgeries.


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