Your Next Orthopedic Competitor Might Be Across State Lines

New research suggests that orthopedic patients may be willing to travel farther for surgery than providers expect. For healthcare marketers, that raises some interesting questions about how we define competition, patient access and growth.

When we think about competition in healthcare, geography tends to play a pretty big role. We look at the practices down the street, the health system across town and the orthopedic group opening a new location a few miles away.

It makes sense. Healthcare has historically been a local business, and convenience still matters when someone is choosing where to receive care.

But what happens when the competition isn’t necessarily the practice closest to your patients?

A recent study published in The Journal of Arthroplasty offers an interesting perspective on that question. Researchers examined patients receiving outpatient hip and knee replacements at ambulatory surgery centers (ASCs) along the Illinois-Indiana border. What they found suggests that where patients receive orthopedic care can be influenced by much more than proximity.

And for orthopedic organizations thinking about growth, that’s worth paying attention to.

When the State Line Doesn’t Stop the Patient

The study looked at 7,503 patients who underwent outpatient hip or knee replacement procedures between 2016 and 2024 at eight surgery centers affiliated with a single orthopedic practice. Four centers were in Illinois, and four were in Indiana.

Here’s where things get interesting.

Illinois patients were 3.7 times more likely to cross state lines for surgery than their Indiana counterparts. More specifically, 28.4% of Illinois patients received surgery in Indiana, compared with 7.7% of Indiana patients who traveled to Illinois.

Even more surprising, 67.3% of Illinois patients who crossed the border had a closer surgery center available in their home state.

The researchers examined these patterns in relation to certificate-of-need regulations, which can limit the development of new ambulatory surgery centers. Illinois and Indiana have different regulatory requirements, creating an opportunity to study how those differences may influence where procedures take place.

It’s important to recognize that this was a study of one orthopedic practice operating across two states, not evidence that patients everywhere are suddenly traveling farther for care.

Still, it reveals something worth exploring.

The closest orthopedic provider isn’t necessarily the one a patient ends up choosing.

Source: Carlock et al., The Journal of Arthroplasty, 2026.

Your Market Might Be Bigger Than You Think

Orthopedic marketing strategies often begin with a defined geographic footprint. Organizations identify their service areas, evaluate nearby competitors and build campaigns around reaching patients within those boundaries.

There’s nothing inherently wrong with that approach. Geography is an important part of understanding any healthcare market.

But geography alone doesn’t tell the whole story.

A patient may live ten minutes from one surgery center and still receive care somewhere else. Their decision might be influenced by their surgeon’s recommendation, insurance coverage, facility availability, scheduling or the location where their preferred physician performs procedures.

In some cases, the patient may not even think of the decision as choosing between competing surgery centers. They’re following the care pathway established by a physician they already trust.

That creates an important distinction for marketers.

The market where your patients live and the market where they receive care aren’t always the same.

If we’re only evaluating competitors within a predetermined radius, we could be missing organizations that are attracting patients from the very communities we’re trying to reach.

We could also be overlooking opportunities in neighboring markets where patients are already traveling to access care.

The Outpatient Shift Is Changing the Competitive Picture

This research becomes even more interesting when we consider what’s happening with orthopedic surgery more broadly.

Procedures that once required a hospital stay are increasingly being performed in outpatient settings. Advances in surgical techniques, anesthesia, recovery protocols and patient selection have helped make outpatient joint replacement a viable option for appropriately selected patients.

A November 2026 study in Health Affairs found that more than 75% of knee replacements among the Medicare patients studied were performed on an outpatient basis five years after the procedure was removed from Medicare’s inpatient-only list.

That’s a significant change in where care is delivered.

As orthopedic procedures move into different settings, the competitive landscape changes with them. Independent surgery centers, hospital outpatient departments and physician groups may be competing for patients whose decisions are shaped by referral relationships, access and facility options.

For marketing teams, this means the competitive analysis we completed a few years ago might not reflect the market we’re operating in today.

A practice’s biggest competitive threat could be a newly established outpatient facility, a regional orthopedic group expanding its surgical capabilities or an organization building stronger relationships with referring physicians.

And some of those competitors may be located well outside the area we’ve traditionally considered our market.

What Does This Mean for Orthopedic Marketing?

Before expanding a campaign into a neighboring county or increasing advertising to defend an existing market, orthopedic organizations need a clearer picture of how patients are moving through their region.

That starts with looking beyond the usual competitive research.

Where are your patients coming from?

Patient origin data can reveal whether your organization is attracting people from outside its traditional service area. It can also help identify communities where demand exists but awareness or access may be limited.

Where are patients going for care?

Understanding referral patterns, competing facilities and the availability of outpatient procedures can provide valuable context. Losing patients to another organization isn’t always a marketing problem. Sometimes it’s an access issue, a referral relationship or a limitation in where procedures can be performed.

What influences the decision?

Patients don’t all choose orthopedic care the same way. Someone seeking a sports medicine consultation may prioritize different things than a patient preparing for a total knee replacement.

The role of physician reputation, convenience, insurance, referrals and facility availability can vary depending on the procedure and the patient.

Those differences should influence how an organization positions itself and where it invests in growth.

Are you marketing to the right geography?

A larger geographic footprint isn’t automatically a better one. The goal is to identify the markets where your organization has a meaningful opportunity to compete, then understand what it would take to attract and serve patients from those areas.

That might mean strengthening physician referral relationships, improving local visibility, developing location-specific messaging or reconsidering how marketing supports an expanding outpatient network.

The right answer depends on what’s driving patient behavior in the first place.

Better Market Intelligence Leads to Better Growth Decisions

One of the things I find most interesting about this study is that it challenges an assumption many of us make without giving it much thought.

We tend to organize healthcare markets around boundaries. City limits, counties, states, designated service areas. They’re convenient ways to structure research, reporting and campaigns.

Patients, however, don’t always make decisions according to those boundaries.

And as orthopedic care continues to evolve, understanding where patients are going, why they’re going there and what influences those decisions becomes increasingly valuable.

At Advance Healthcare Marketing, we’re spending more time thinking about how market intelligence can help healthcare organizations identify the challenges and opportunities behind their growth goals.

Because sometimes the answer isn’t reaching more people with a bigger campaign.

It might be recognizing that the people you’re trying to reach are already looking for care somewhere you haven’t been paying attention to.

The Illinois-Indiana study doesn’t tell every orthopedic organization to expand its geographic footprint. It does give us a good reason to question whether the boundaries we’ve drawn around our markets still make sense.

Your next orthopedic competitor might be across state lines. Your next growth opportunity might be, too.