5 Insights Into the Rising Role of Joint Replacement in Workers’ Compensation

Upward trends in joint replacement surgeries have been commonplace in the general population for decades, with the National Institute of Health expecting a 382% increase by 2060. As well-documented as those trends have been, there have been only a few past studies on their impact on workers’ compensation claims. The Workers Compensation Research Institute (WCRI) released a new study that provides insight into the latest joint replacement trends and how they specifically relate to workers’ compensation.

“A joint replacement can be the difference between mobility and disability in an injured worker, so it is no surprise that their frequency has increased in recent years,” said Lisa Strader, Senior Medical Manager at Safety National. “Outpatient, same-day, and robotic-assisted surgery trends have led to more precision in implant placement, and more durable materials are reducing post-surgery risks, like dislocations.”

WCRI’s report on Recent Trends in Joint Replacement Among Workers’ Compensation Claims spotlights the composition of these surgeries and potential costs in workers’ compensation claims with 24 months of medical treatment occurring between 2015 and 2022.

1. Joint replacements are shifting from an inpatient to an outpatient procedure.

Focusing on three major anatomic sites, including shoulder, hip, and knee joint replacements, WCRI’s data noted an 18% increase in replacements over the study period, driven primarily by an increase in shoulder replacement surgeries. Notably, these procedures have shifted dramatically to an outpatient setting, accounting for only 13% of surgeries in 2015 compared to 48% in 2021. Only 1 in 4 joint replacement claims included an inpatient procedure in 2021.

 2. Knee and shoulder joint replacements accounted for nearly 80% of all joint replacement procedures.

Shoulder joint replacement claims increased from 24% to 36% between 2015 and 2021. However, representing the largest category of joint replacements, knee surgeries accounted for 43% of all claims. Hip replacements ranked third, accounting for 21% of claims.

 3. Preexisting injuries and the level of care prior to surgery were major contributing factors in the timing of surgeries.

The timing of a replacement can vary depending on treatment urgency, such as when fractures occur, often requiring immediate medical attention. WCRI notes that hip fractures were more common conditions needing early intervention compared to fractures in shoulder and knee replacement claims. Knee surgeries were the most delayed, with more than half occurring a year after the injury date.

 4. Total costs for claims with joint replacements ranged from $116,000 to $129,000 per claim.

Medical payments per claim were $65,775 for those with joint replacements, which was much higher than for all lost-time claims in the study. The average temporary disability for joint replacement claims was 51.2 weeks, accompanied by an average indemnity payment of $49,448. Shoulder joint replacements had the highest costs, whereas knee replacements had the lowest. However, knee replacements were associated with the longest period of temporary disability.

 5. Rates of surgical revisions in joint replacements vary.

Revision surgery may be necessary for a variety of reasons, but typically these procedures follow an infection, mechanical loosening, instability, or wear and tear on the materials. While early revision surgeries, within a year of the initial surgery, are uncommon, they can occur. Overall, WCRI noted a 3-4% revision rate in joint replacement claims within its study period. However, these rates fluctuate on an individual anatomic basis. For example, hip replacement revisions trended down from 4% to 1.4%.