More incredible insights into rising federal sickness-care costs reported as news in the Wall Street Journal (9/26/12): It seems that old people enjoy walking pain free. Fortunately, through the miracle of modern orthopedics, we can now go into a medical shop and get mechanical replacements. Good news right? Well, for the most part.
It seems the all these medical breakthroughs and applications cost money. Lots of money—say about $15K per knee. But for those 65 and older and eligible for the federal insurance program for older Americans, about 243,802 had one or more knees replaced last year to the tune of about $9 billion.
In keeping with the spirit of fair play, candidates denied the procedure should be given a six month, do-it-yourself, shape-up or ship-out program and then one more chance to qualify.
Because a growing percentage of the population is turning 65 and over, demand for these operations could reach 3.5 million by 2030, according to the American Medical Association. That’s a lot of knees and a lot of old people, but what the heck. It beats paying for a nurses and wheelchairs.
But if you are a younger taxpayer, you might be interested to know about the success of these operations. Well, apparently the docs who perform these surgeries don’t do a very careful job of tracking long-term outcomes.
Knee replacement success depends on the patient’s age and, most of all, his or her physical condition at the time of the surgery. One major risk factor is the extent to which the patient has good muscular strength and their percent body fat. Weak, fat, older patients do not rehab as well as fit, leaner patients. Variability of fitness among people over 60 is remarkable. Older people are, like the general population, fatter than ever. And fat, older people do not choose to move at a sufficient level of frequency and intensity to maintain bone density, leg strength, and flexibility. (That is unless they follow recommendations of Da Coach.)
As word gets around about the success of knee transplants, more and more older people want new knees. Unfortunately, not more want to lose fat and get into shape to maximize the probability of a favorable outcome.
This raises the question: Should older candidates for joint replacement be expected to get in shape for the surgery and commit to post-op rehabilitation? Should surgery be done on a first come, first served basis? Who is going to decide who receives the surgery and who is not? “Ultimately there’s going to be (only) some number of these we can afford,” reports Peter Cram, a health-policy researcher and internist quoted in this article.
Da Coach had total replacement in both knees at the same time in 2005. He could hardly walk before surgery and was in constant pain. Ten days after surgery he was fully ambulatory. In four weeks, he went dancing. He has full range of motion in both knees and is able to do anything, although he has replaced running to promote cardio/pulmonary fitness with the elliptical machine, cycling and swimming.
This article concludes with another quote from Dr. Peter Cram regarding what happens when there are more knees in need of replacement than there is money to pay for them: “… how to limit the procedure or who should get it will be a ‘really contentious debate,’ ” he says.
Da Coach says it will be simple: Measure each candidate’s percent body fat, general level of fitness (especially lower body strength and flexibility), and take whatever percentage of fit candidates the budget can handle. It’s called survival of the fittest.
In keeping with the spirit of fair play, candidates denied the procedure should be given a six month, do-it-yourself, shape-up or ship-out program and then one more chance to qualify.
Another more reasonable long-range option that has been generally rejected by health officials, educators, boards of education, and public health authorities: Teach quality daily physical education in public schools backed up by strong community recreation and fitness programs from the cradle to the grave.
This will reduce both the percentage of knee replacements and the levels of obesity that are a primary risk factor for such orthopedic distress.
Da Coach