Price Transparency and Consumer Perceptions of Generic and Brand-name Implants in Orthopaedic Surgery

Document Type : RESEARCH PAPER


1 Department of Orthopedic Surgery, The University of Oklahoma College of Medicine, Oklahoma City, OK, USA

2 Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Second Floor, New York, NY, USA

3 Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA


Background: Some have suggested the use of generic surgical implants to curb rising costs of orthopaedic care. 
However, there is evidence that patients are reluctant to use generic pharmaceuticals as compared to their brand name 
equivalents for fear of inferior quality. Public perception of the use of generic implants remains unknown. 
Methods: We conducted a cross-sectional survey using Amazon MTurk to identify factors associated with a consumer 
preference for generic orthopaedic screws and total hip. 
Results: While much of the public (52%) sees the value of generic implants, fewer (26%) would prefer them in their 
own care. Most respondents (75%) trust their surgeon’s choice, yet the vast majority (83%) want to be informed about 
the cost of their implant, even if it makes no difference in what they pay. The agreement that older implants are safer 
than newer implants (OR 1.9 for screws; 2.5 for hip arthroplasty), and that generics are a better value than brand name 
implants (OR 3.0 for screws; 4.3 for hip arthroplasty) were independently associated with a preference for generics.
Conclusion: The observation that many people view generic implants as being a good value, yet fewer would prefer 
to use them in their own care indicates that concerns over quality may initially limit utilization of generic implants. More 
evidence is needed to reassure most consumers of the safety and effectiveness of generic implants. Additionally, our 
findings demonstrate a desire for more implant price transparency when undergoing orthopaedic surgery.
Level of evidence: II


1. Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, 
Whitehouse MR. How long does a knee replacement 
last? A systematic review and meta-analysis of case 
series and national registry reports with more than 15 
years of follow-up. Lancet 2019;393(10172):655-663. 
doi: 10.1016/S0140-6736(18)32531-5.
2. Sculco TP. The economics of new age arthroplasty: 
can we afford it? Orthopedics 2010;33(9):628. doi: 
3. Hemalatha Kandula, Monika Darandale, Onkar 
Sumant. Orthopedic Implants Market. Medical 
Devices & Supplies. Available at: https://www. Accessed NOV, 2007. 
4. Atrey A, Heylen S, Gosling O, Porteous MJ, Haddad FS. 
The manufacture of generic replicas of implants for 
arthroplasty of the hip and knee: is it regulated and 
will it save money? Bone Joint J 2016;98-B(7):892-
900. doi: 10.1302/0301-620X.98B7.37016. 5. Hustedt J, Goltzer O, Bohl D, Fraser J, Lara N, Spangehl 
M. Calculating the Cost and Risk of Comorbidities 
in Total Joint Arthroplasty in the United States. J 
Arthroplasty 2017;32(2):355-361.e1. doi: 10.1016/j.
6. Lybrand KE, Althausen PL. The Role of Value-Based 
Implants in Orthopedic Trauma. Orthop Clin North Am 
2018;49(4):437-443. doi: 10.1016/j.ocl.2018.05.005.
7. Waddell JP, Morton J. Generic total hip arthroplasty. 
Clin Orthop Relat Res 1995;(311):109-16.
8. Mortensen K, Hughes TL. Comparing Amazon’s 
Mechanical Turk Platform to Conventional Data 
Collection Methods in the Health and Medical Research 
Literature. J Gen Intern Med 2018;33(4):533-538. doi: 
9. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez 
N, Conde JG. Research electronic data capture 
(REDCap)—a metadata-driven methodology and 
workflow process for providing translational research  informatics support. J Biomed Inform 2009;42(2):377-
81. doi: 10.1016/j.jbi.2008.08.010.
10.Shrank WH, Cox ER, Fischer MA, Mehta J, Choudhry NK. 
Patients’ perceptions of generic medications. Health 
Aff (Millwood) 2009;28(2):546-56. doi: 10.1377/
11.Omojasola A, Hernandez M, Sansgiry S, Jones L. 
Perception of Generic Prescription Drugs and 
Utilization of Generic Drug Discount Programs. Ethn 
Dis 2012;22(4):479-85.
12.Sewell K, Andreae S, Luke E, Safford MM. Peer 
Reviewed: Perceptions of and Barriers to Use of Generic 
Medications in a Rural African American Population, 
Alabama, 2011. Prev Chronic Dis 2012;9:E142. doi: 
13.Shrank WH, Cadarette SM, Cox E, et al. Is There 
a Relationship Between Patient Beliefs or Communication About Generic Drugs and Medication 
Utilization? Med Care 2009;47(3):319-25. doi: 
14.Shiv B, Carmon Z, Ariely D. Placebo effects of 
marketing actions: Consumers may get what they pay 
for. Journal of marketing Research 2005;42(4):383-93. 
15.Rohman L, Hadi S, Whitwell G. Surgeons’ knowledge 
about the costs of orthopaedic implants. J 
Orthop Surg (Hong Kong) 2014;22(2):221-3. doi: 
16.Bozic KJS, Khaled J. Rosenberg, Aaron G. Rubash, 
Harry E. Economic evaluation in total hip 
arthroplasty: analysis and review of the literature. J 
Arthroplasty 2004;19(2):180-9. doi: 10.1016/s0883-