Knee and hip replacements: What you need to know

@Money August 5, 2011: 4:35 PM ET
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(MONEY Magazine) -- Before you have a major joint replacement surgery, here are five things you need to know.

1. They don't last forever

While artificial joints are more durable than they used to be, the typical patient who gets one today will need another in about 20 years, says Dr. William Maloney, chair of orthopedic surgery at Stanford University School of Medicine.

Most private insurers and Medicare cover the procedure, but even so, out-of-pocket costs can easily hit $3,000 -- much more if you go out of network.

To put off your date with the scalpel, ask your doctor about physical therapy, anti-inflammatory drug treatment, and cortisone shots, which may buy a couple more years for someone with arthritis. And switch to low-impact activities such as swimming rather than jogging, which can lengthen any joint's life span.

2. Expertise is paramount

Studies show that patients of surgeons who do lots of hip and knee replacements tend to have fewer complications. (Problems are more common than you might think: "The Journal of Bone and Joint Surgery" reports that 6% of such surgeries must be redone within five years.)

Choose a doctor who does at least 100 annually and has completed a joint-replacement fellowship, advises Dr. Matthew Kraay, director of joint reconstruction and arthritis surgery at University Hospitals Case Medical Center in Cleveland.

3. Newer doesn't always mean better

In the race to innovate, some joint makers crank out lemons. Last August, for example, a division of Johnson & Johnson (JNJ, Fortune 500) recalled two metal hip systems that had already been implanted in about 93,000 patients, some of whom required a do-over.

"The recalls tend to be for new technologies," says Maloney. So ask your surgeon for a joint that has a proven record of at least five years or so, suggests Kraay. While no searchable consumer database contains this information, many hospitals and health care systems track it.

4. Surgical costs are just the beginning

During the typical four- to 12-week recovery, you'll probably need crutches or a walker, an elevated toilet seat, and bathroom grab bars. And you may need to hire people to drive and bathe you and provide household help.

Medicare covers crutches or a walker, as do most private insurers, says Bruce Roffe of insurance consultancy H.H.C. Group. You're generally on your own for the rest (though you can pay for other equipment out of your flexible spending account). If you're 65 or older, keep costs down by calling your local agency on aging (find it at eldercare.gov); many offer free or low-cost services.

5. Your paycheck may suffer

Not yet retired? If you're employed by a large company, short-term disability is likely to cover you once you've used up your allotted sick days -- but typically at only 60% of your pay, according to Denise Fleury, a senior associate at human resources consulting firm Mercer.

To keep your income from shrinking, several months before you schedule your surgery, present a plan to your boss that will keep your leave as short as possible. For example, have the procedure during the slow season and work from home -- or put in half days -- until you've fully recovered.  To top of page

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