metal screws, plates, and rods. It is reasonable to conclude that more than
ten thousand patients a year in America require major implant surgery for
serious ankle problems.
In the United States, there were approximately sixteen thousand thumb
and finger replacement operations and twelve thousand toe replacement
operations in 2014, according to SmartTRAK, an orthopedics industry
analyst.^17
In sum total, in the year 2014 (the most recent year for which we have
the most reliable data), there were 522,800 total hip replacements, 723,100
total knee arthroplasties, 90,000 total shoulders, 15,000 elbow
replacements, 16,000 thumb and finger replacements, 12,000 toe
replacements, 2,000 ankle replacements, and 2,000 wrist replacements.
The grand total of all joint replacements in America was 1,381,300 in
- There is a small subset of patients who received more than one joint
replacement in a single calendar year, so it is not accurate to conclude that
1,381,300 unique Americans had a joint replaced in 2014, but until the
United States. has a joint registry, this tabulation is as close to accurate as
we may produce. This number will swell to roughly two million joint
operations every year by the time this book goes to press and four million
every year by the year 2030.
Spinal fusion surgery is the costliest inpatient operation in America.
Although spine surgery cases are about half the volume of knee
arthroplasty operations, the mean costs are almost double. In 2014, there
were 413,200 inpatient stays for spinal fusion surgery, with nearly all
requiring metal screws, plates, and/or rods.^18 Although laminectomy or
disc removal spine surgery is the fifteenth most expensive operation (with
aggregate costs of $2.3 billion), these operations, which do not involve
device insertion, are not central to this implant-focused tabulation.
Nonetheless, spine fusion surgery is massively expensive, representing
over 7 percent of all operating room costs in 2014.^19 Because many spine
operations are now performed on an outpatient basis, the above noted
number of 413,200 spine operations vastly underestimates the actual
number of operations performed. Cooperative industry tracking estimates
compute the number of instrumented spine operations in 2014 as 778,180
operations.^20 Roughly a half-million Americans have spinal implants
inserted into their bodies annually, about a third of which (155,900) are
between sixty-five and eighty-four, representing somewhere in the