66 KIPLINGER’S PERSONAL FINANCE^ 05/2017HEALTHY LIVING
surgery in early November at a local
hospital affiliated with the Mayo
Clinic system and “never looked back,”
she says. Her recovery was quick and
uneventful. By January, she and her
husband, Jeff, had returned to riding
their snowmobiles (gingerly, on her
part), and by spring, she was raring to
hit the road on her Harley-Davidson.HOW THE SURGERY WORKS
Joint replacement—known as arthro-
plasty—is one of the most common
operations in the U.S. and the most
common among patients covered by
Medicare. About a million such sur-
geries are performed annually, and
the number will rise significantly as
boomers grow older and live longer.
Increasing numbers of younger people
need the surgery, too, because of obe-
sity and injuries from athletic activity.
Arthroplasty was introduced in
the 1960s, and the basic strategy re-
mains the same: An orthopedic sur-
geon removes damaged bone and
cartilage from the joint and installs
prosthetic components made of
metal, ceramic and plastic to create
a smooth-running, durable joint.
Knee replacement involves resurfac-
ing the knee’s components: the lower
end of the thigh bone (the femur), the
upper end of the shinbone (the tibia),
and the kneecap (the patella). In a nor-
mal joint, the ends of these bones are
covered with cartilage to protect them
and allow them to move smoothly. In
an arthritic joint, the cartilage is dam-
aged or worn away. During the opera-
tion, the surgeon cuts away the dam-
aged cartilage and bone at the ends of
the long bones, positions and secures
the metal implants, and in some cases
cuts and resurfaces the back of the knee-
cap with plastic. A plastic spacer is in-
serted between the metal components
to create a smooth gliding surface.
Partial knee replacement is a slightly
less extensive surgery than a total over-
haul, with a slightly faster recovery. It
may be appropriate if arthritic damage
is limited to just one of the three com-
partments of the knee (inside, outsideor front), but that’s relatively uncom-
mon. By the time most people experi-
ence pain in one part of the knee, they
have damage to the other parts, too.
In a hip replacement, the surgeon
removes the damaged head of the
thigh bone and replaces it with a metal
stem inserted into the hollow center
of the bone. The surgeon either ce-
ments or “press fits” the stem into the
bone and attaches a metal or ceramic
ball to the stem. He cuts away the
damaged cartilage surface of the hip
socket and replaces it with a metal
socket, which may be secured to the
pelvis with cement or screws. Finally,
he inserts a plastic, ceramic or metal
spacer between the ball and the socket
to create a smooth gliding surface.HIGH-TECH AND A BIT OF HYPE
Joint replacement is not just a boon
to hurting baby boomers; it is also a
lucrative business. Surgeons and hos-
pitals often compete for patients by
touting a particular product, tech-
nique or surgical strategy.
For instance, some surgeons repeat
manufacturers’ claims that the replace-
ment they use produces the “best knee
for an athlete” or “best knee for a
woman.” In fact, all hip and knee im-
plants have become more durable and
anatomically accurate than they used
to be and function more naturally
thanks to innovations in design and
materials, including a wear-resistant
plastic that all manufacturers use. These
implants come in all sizes and can be
mixed and matched to create an exact
fit for any patient, says Dr. Mark Pag-
nano, professor and chairman of the
department of orthopedic surgery at
the Mayo Clinic, in Rochester, Minn.
“Minimally invasive” surgery,
which generally means a smaller inci-
sion with less disruption of surround-
ing soft tissues, is also widely adver-
tised. Although it’s true that many hip
and knee replacements can be done
with a smaller incision than, say, 20
years ago, there are several techniques
touted as minimally invasive, and the
term has no universally agreed-upondefinition. Ask surgeons what they
mean by minimally invasive and
whether you’re a good candidate for
the approach.
Many surgeons vigorously advocate
for one of two ways to access the hip
in surgery: posterior (from the back of
the hip) or anterior (from the front).
A recent study conducted by the Mayo
Clinic found that both approaches pro-
vided excellent postoperative recovery
with a low complication rate, although
the patients who had direct anterior
surgery had a slightly faster recovery.
The risk of dislocating the hip follow-
ing surgery is low in both groups (less
than 1%), but contrary to some claims,
the anterior approach doesn’t elimi-
nate that possibility, according to
recent data from the Michigan
Arthroplasty Registry.
What about using three-dimen-
sional printing to custom-make a new
joint for you? The technology is in use
today, but it doesn’t necessarily make
implants fit better than they do with
other technology, says Pagnano.ANTICIPATING THE OUTCOME
Surgical protocols have advanced re-
markably over the past decade. Now,
serious complications occur in fewer
than 2% of patients, according to the
American Association of Orthopaedic
Surgeons. Still, over time joint im-
plants may be damaged and loosen
from normal wear and tear, a fracture,
or infection (which is always a possi-
bility because the surfaces of the im-
plant provide a place for bacteria to
take hold). If the replacement fails,
you may experience pain, stiffness,
instability or loss of function, and a
redo, or revision, may be in order.
How long can you expect a new joint
to last? “Joint replacements don’t come
with an expiration date, where they all
suddenly start to fail,” says Pagnano.
There’s about a 0.5% to 1% chance of
a problem arising for every year after
surgery. So you have a 90% to 95%
chance that a joint will still work well
after 10 years, an 80% to 85% chance
after 20 years and so on. For many