Time-Driven Activity-Based Costing in Preoperative Tasks for Total Hip and Knee Arthroplasty

David S. Constantinescu, Sagie Haziza, Dennis J. Vanden Berge, Colin A. McNamara, Victor H. Hernandez, Michele R. D'Apuzzo

Research output: Contribution to journalArticlepeer-review


Background: Substantial work in the preoperative phase of total hip arthroplasty (THA) and total knee arthroplasty (TKA) is unaccounted for in current Relative Value Scale Update Committee methodology. A Time-Driven Activity-Based Costing (TDABC) analysis allows for an accurate assessment of the preoperative costs associated with total joint replacement surgery. Methods: The mean time that clinical staff members spent on preoperative tasks per patient was multiplied by the hourly salary. Clinical staff members included orthopedic surgeons, nurse practitioners or physician assistants, nurses, medical assistants, and surgical coordinators. Mean time spent on preoperative tasks was obtained from the most recent literature. Salaries were obtained from the nationwide database provided by Glassdoor Inc. Results: Total time spent among clinical staff involved in preoperative tasks for each arthroplasty patient was 8.45 hours (2.96-13.94). Total TDABC was calculated to be $348.17 (132.46-562.64). Accounting for preoperative tasks, the TDABC for TKA/THA increases from $13321.5 to $13669.67. Preoperative tasks are composed of 2.6% of total TKA/THA TDABC. In 2020, an estimated $544,189,710 of preoperative TKA/THA work was completed. Conclusion: Surgeons, providers, and ancillary staff involved in THA/TKA spend a cumulative preoperative work time of approximately 8.5 hours per patient, which equates to $348.17 that is currently unaccounted for in Relative Value Scale Update Committee methodology.

Original languageEnglish (US)
Pages (from-to)809-813
Number of pages5
JournalJournal of Arthroplasty
Issue number5
StatePublished - May 2022
Externally publishedYes


  • arthroplasty
  • costs
  • hip
  • knee
  • optimization
  • time-driven activity-based cost

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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