I’m 59-years-old and in good health. I guess you could say I’m part of the group they call the worried well. I worry that there won’t be Social Security for me when I need it. I worry that I’ll get arthritis in my one bum knee. I’ve already heard there won’t be enough knee replacements to go around should I need one in the next 10 years. Will all the new focus on health care reform, is anybody doing anything about these problems? That’s what I want to know.

We can’t guarantee how things will go in the future. But some of the best minds in this country are discussing the state of our health care delivery system. They know that a little effort goes a long way in preventing a disabled system from breaking down altogether.

And the American Academy of Orthopaedic Surgeons has made it clear that the predicted growth in patient demand for joint replacements is going to outpace the number of surgeons available to provide them. Advanced technology and improved surgical technique has made joint replacement easier and safer than ever before. There are fewer risks and complications. This is especially true in the older population — another reason why joint replacements are becoming so popular. What’s the answer to this supply and demand dilemma? Some experts suggest that avoiding this problem is possible.

They say that policy makers need to increase the rate of reimbursement to surgeons for total joint procedures. Medicare keeps reducing how much they will pay while the costs of doing business in the health care world continue to rise. Another possible solution is to prioritize patients according to need and predicted outcome. What does that mean?

Well, we know, for example, that patients who have worse function before surgery tend to have poorer outcomes after surgery. Women and certain ethnic groups (e.g., Hispanic, African American) fall into this category. It may be a coincidence that these patients have worse function before seeking out a joint replacement. Or it may be that people in these groups delay treatment for too long. Lack of insurance, cultural issues, or less access to care may also be reasons for this delay. Getting them in for surgery sooner than later may actually improve their results.

All of this points to the need for education. First, for the policy makers responsible for determining reimbursement rates on surgical procedures. Then to aging adults who are starting to develop joint problems. With modified activity, strengthening exercises, and medications, the effects of osteoarthritis can be prevented and managed much longer. It may be possible to reduce the need for joint replacements (or at least delay surgery it without affecting the final results).

Your concerns are well founded. In order to stay fit and active, 30 to 45 minutes of exercise is recommended each day. For those who want to lose weight, 60 to 90 minutes of activity and exercise is needed. A strengthening program will help protect the joints from excess load and stress. Proper shoes, good posture, and avoiding repetitive motions are all helpful ways to protect the feet knees, hip, and spine — all contributing to good joint health. If you need help finding the right path, see a physical therapist. A therapist can help answer some of your questions, assess your musculoskeletal health, and steer you in the right direction.