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Position Statement

Value Driven Use of Orthopaedic Implants

This Position Statement was developed as an educational tool based on the opinion of the authors. It is not a product of a systematic review. Readers are encouraged to consider the information presented and reach their own conclusions.

There has been significant growth in the services that orthopaedic surgeons provide to patients with musculoskeletal disorders. Many of the new innovations which have helped transform orthopaedic surgery as a specialty have been technology driven. Implantable orthopaedic devices are a significant component of the advances in musculoskeletal care, and currently, roughly half of orthopaedic surgical procedures utilize an implantable device.

The positive impact that orthopaedic technology has had on our profession and our patients has also created new challenges which need to be addressed. The rising costs of many orthopaedic implants now overshadow the reimbursement for the orthopaedic procedure. These costs of implants increase pressure on orthopaedic providers and threaten their ability to deliver a high level of technology driven orthopaedic care for their patients.

One of the greatest challenges for all health care providers is to manage effectively the cost of care. This is particularly true in an environment where concerns about rising costs and variable quality of care have led some experts to question the long-term viability of our health care system.1 Addressing these challenges will require more comprehensive collaboration between all healthcare stakeholders particularly as they relate to controlling rising healthcare costs.

As we enter an era of increased transparency, quality measurement and value-based purchasing of health care, orthopaedic surgeons have an important role in the appropriate and value-driven utilization of implantable orthopaedic devices. The primary responsibility of orthopaedic surgeons is to act in the best interest of their patients. Additionally, however, they need to consider the value of orthopaedic interventions to help control the cost of their care to ensure that future patients will have appropriate access to high quality musculoskeletal care.

The American Association of Orthopaedic Surgeons (AAOS) believes orthopaedic surgeons should work collaboratively with their facilities, patients, payers, medical device companies, and other physicians to enhance the value of orthopaedic procedures. This should include the adoption of reasonable clinically based criteria for selection of orthopaedic implants with the appropriate consideration of cost. The final authority for selecting implants should rest with the treating orthopaedic surgeon who is committed to providing the highest quality, patient centered care.


1. Knowing What Works in Healthcare: A Roadmap for the Nation. Institute of Medicine of the National Academies, 2008.

February 2009 American Association of Orthopaedic Surgeons.

This material may not be modified without the express written permission of the American Association of Orthopaedic Surgeons.

Position Statement 1104

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