In 1994, we found out that our large practice of complex knee- and hip-joint replacements lost money—actually about $2 million per year. When you are an orthopedic surgeon and working very hard and dealing with patients referred by other orthopedic surgeons, this is very difficult to accept. Partly this reflected the nature of our practice, as we do a fair number of surgeries to replace failed implants, but it also resulted from things we were doing—keeping people in the hospital too long, for instance. Most significantly, however, the loss stemmed from the implants we were using, for we were implanting 10 to 12 versions of half a dozen major designs for any one clinical indication. Clearly, things ...

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