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Forever Young

The Latest in Joint Replacement

Americans who want to stay active or who simply need to alleviate the chronic pain of osteoarthritis increasingly are turning to joint replacements as remedies. But it’s less certain that the latest innovations in prosthetics, surgical procedures and pain management are worth braving the surgeon’s knife.

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Smith & Nephew

For Larry Greco of Frisco, Texas, osteoarthritis in his right hip made tying his shoes torture and led to a hip replacement in 2002.

Then last year, when pain flared up in Greco’s left hip, his uncle told him about a new procedure called anterior approach hip replacement. In this procedure, surgeons insert an implant through a 4- to 5-inch incision in front of the hip.

For his first hip replacement, Greco, 57, was hospitalized 5 days and resumed driving 2 months later. This time, he was home in 2 days and behind the wheel in less than a week. Now he’s feeling no pain in his replacement hips and, this time, less sting in his wallet. He had a shorter hospital stay, and he exercised at home instead of enduring 3 months of rehabilitation. The changes slashed his bill in half (to about $20,000).

Although the jury is still out on whether this new approach beats traditional hip replacement, the verdict is in on this: In the past few years, the growing need for joint replacement (or arthroplasty) has mothered a wave of innovation. New surgical procedures are available for bum hips, knees, shoulders and, to a much lesser degree, other joints.

But good outcomes are not a slam dunk, particularly from pricier unproven technologies, and your out-of-pocket costs can vary wildly depending on your  health insurance plan. Joint replacement also probably is not a permanent solution. Although today’s products are constructed from materials that should last longer than previous materials, chances are good that if you get a replacement before you qualify for your AARP card, you’ll need to shell out big bucks for a second replacement in 15 to 20 years.

BAD TO THE BONES. The joints are really jumpin’, especially when you’re talking about the rise in replacements in recent years. Consider this: According to American Academy of Orthopaedic Surgeons (AAOS), the number of first-time total-knee arthroplasties (TKAs) jumped 24 percent to 498,169 in 2005 from 402,000 in 2003. Total-shoulder arthroplasties (TSAs) increased a whopping 50 percent over the same time, to 15,000  from 10,000. (Numbers for 2006 or 2007 were not available at press time.)

It’s a surge not slowed even by rising costs—between 2002 and 2005, average surgical and hospitalization costs for TKAs rose to $36,000 from $29,000, while total hip arthroplasties (THAs) increased to $39,000 from $31,000. Out- of-pocket costs vary depending on the insurer but can easily reach $1,500 for these expensive procedures.

Previously, surgeons advised people plagued by conditions, such as osteo-arthritis (an estimated 27 million Americans live with the condition, according to National Arthritis Data Workgroup), to “tough it out” and avoid drastic joint-replacement surgery until age 60. This was because surgeons “did not feel the implants would last long enough to outlive the patients,” says Dr. John Hur, an orthopedic surgeon in Indianapolis.

That sentiment has changed. Today, bearing surfaces, material that helps reduce the friction between secured and moving parts of the artificial joint, are made of ceramics and high-tech metals, such as cobalt chromium or titanium alloy. Other parts of the new joint are constructed of more-durable plastics, such as ultra-high-molecular-weight polyethylene. Nowadays, even those younger than 45 are having joints replaced. That trend is expected to continue. In fact, Steven Kurtz of scientific consulting firm Exponent projects that in 2030, 58 percent of all joint-replacement surgeries will be performed on people younger than 65.

Naturally, the sky-high and rising cost of joint-replacement surgery and the increase in younger patients having it aroused our skepticism. Are more people being led to a quicker conclusion that they need pricey joint-replacement surgery by a medical community with one eye on the bottom line?

Dr. Stephen Barrett of Quackwatch, a nonprofit organization that provides information on health-related fads and myths, doesn’t believe that.

“The people I know were certainly not pushed to have it,” he says of joint-replacement surgery. “All were advised, on general principles, to wait until their pain became unbearable.”

Hur agrees. “Conservative treatment should always be tried first,” he says. “It’s lower risk than surgery.” Not to mention less expensive.

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