What's a knee worth?

Photo by popeye logic

What’s a knee worth? Before you answer the question, try getting along without one.   

I’ve always had dodgy knees. When I was a kid I got charley horses so bad it took hours of pain to unkink them. In my 40s I had arthroscopic surgery to suck out little bits of bone that had chipped off my left knee and were floating about in there.  

Four years ago, that knee started buckling awkwardly at the most inconvenient times. It was swollen and so painful that instead of sailing along on my bike through the scented air, I spent much of the spring parked on the couch with an ice pack on my knee. Neither a patient man nor a manly patient, I sulked and whimpered. Why me? And why my legs?  They’re my best feature – sturdy and strong from a lifetime of cycling. I even look good in a kilt.   

So I gobbled acetaminophen and ibuprofen (Vitamin I, my friend Lucie calls it), and soldiered on. It was tolerable for awhile, but by early last year I’d had enough. X-rays showed a damaged knee, but my doc said I should get an MRI to be sure. The wait through Medicare was six months. Being impatient (see above) I ponied up $900 and got an appointment the next day. The place was deserted. 

The MRI is a basically a 360-degree 3-D picture, and it clearly showed what my doc clinically called a “shitty-looking knee”. He sent me off to an orthopedic surgeon who told me I have osteoarthritis. Like a car engine that has run out of oil, my knee had run out of synovial fluid. Without the lubricant, every time my knee moved, it was bone grinding on bone. No wonder it was swollen and sore.

The surgeon recommended an expensive injection to replace the synovial fluid. When that didn’t work, he suggested an expensive knee brace. I pushed for some kind of surgical solution, and he told me they don’t like to replace knees until the patient is at least 65 years old. A typical prosthetic knee lasts about 20 years, by which time the patient is 85 and unlikely to ask for another one.

I persisted, arguing that the sooner my knee was working, the sooner I could get back on the bike, paddle a canoe and do all the other activities that might keep me from being a sedentary, statistically-average geezer gobbling up health care services. The surgeon agreed and, last September, removed my worn-out knee and replaced it with one made of titanium and plastic. I was walking on it the first night. Within a few months I could ride my bike and swing a golf club. I can’t dance the tango, but then I never could.   

According to the Canadian Orthopaedic Foundation there are about 40,000 joint replacement surgeries done in Canada each year, primarily hips and knees. Most of them are due to osteoarthritis. My surgeon told me the average cost of knee replacement surgery is $12,000. Do the math and you come up with almost five billion dollars a year for joint replacements alone. (Health Canada data show that the cost of health care for someone aged 65 to 74 is almost triple that of someone aged 25 to 44.)

A generation ago, knee replacement simply wasn’t an option. Now we can get new parts when our old ones wear out. The technology is there, and so is the demand. No wonder health care costs in Canada rose from about 23 billion dollars in 1980 to more than 180 billion in 2009. 

So with those bewildering figures, what’s a knee worth?  About the same as general good health, which is to say, priceless.  To put it another way, we can spend $12,000 now to get me back on my feet or three times that amount later to keep me in hospital.   Maybe it’s preventative medicine; maybe it’s an indulgence we won’t always be able to afford.  Whichever it is, I feel equal parts of luck and guilt for living in a country where this is possible. 

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