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I just toured a new clinic designed to provide state-of-the-art hip and knee surgery. They even have computer capability to navigate some of the more technical aspects of the operations. Can we really afford this kind of health care? Do we really need it? What about the thousands of people who've gotten joint replacements just fine without all this technology?

You raise some very good questions that deserve consideration. Researchers are applying themselves diligently to answering the risk-to-benefit ratio for many improvements in the health-care delivery system. Computer-assisted technology is one of them. Like all advancements in science and technology, there's always an early investment in research and development. The tremendous cost can seem way beyond the benefit derived by anyone. It brings up the idea that just because we can do something doesn't mean we should. An alternate way to look at this is to see the immediate benefit to a single patient. In the case of procedures like hip replacements or hip resurfacing, computer-assisted surgical navigation makes it possible to fit the implant with greater accuracy. Perfect positioning of the implant is linked with better outcomes. Less wear and tear and lower loads with daily activities are two of the main byproducts. The patient can resume a high level of activity, including sports and recreational involvement. That can translate into greater patient satisfaction, increased well-being, and overall improved general health. Those are hard to put a price tag on. On the other hand, the cost of an implant failure and revision surgery can be calculated. It runs into thousands of dollars. If we multiply that by the number of patients who end up with unavoidable complications and re-operations, then suddenly the value of the technology becomes abundantly clear. Ultimately, time will tell if the visionaries of today were right to move ahead and embrace advancements that may not seem cost-effective right now. But these items could pay off in the future with big dividends.

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