The unnecessary surgery bringing Medicare to its knees

Back in August, I sent out a Daily Dispatch e-letter about a new study showing that a whopping 56 percent of all knee replacements are inappropriate or ineffective. That got me thinking about what kind of financial impact this medical malfeasance is having on our already dysfunctional healthcare system.

I did some sleuthing, and the most recent available data shows that the epidemic of unnecessary knee replacement procedures is causing a serious economic problem—namely bringing Medicare to its knees, and the American taxpayers with it.

And the sad fact is that there are many proven, low-cost, and pain-free alternatives to knee surgery that mainstream medicine and government health bureaucrats simply ignore. I’ll tell you what you need to know to keep your knees healthy and the surgeon’s knife far away in just a moment. But first, let’s take a closer look at what the epidemic of unnecessary knee replacements is really costing the American public.

$2 billion of your hard-earned tax dollars wasted every year

According to a Journal of the American Medical Association study of more than 3 million Medicare Part A beneficiaries, the number of total knee replacements in Americans over age 65 skyrocketed 162 percent between 1991 and 2010.1 In 2010 alone, doctors replaced 243,802 knees.

JAMA reports that the average knee replacement surgery costs $15,000. So that means the total price tag for new knees for the Medicare generation is nearly $3.7 billion per year.

When you consider that more that half of those surgeries are unnecessary, we’re looking at nearly $2 billion worth of wasted Medicare taxpayer dollars every year. That doesn’t even count the extra hospital charges when there are knee surgery complications.

And that jaw-dropping total may only be scratching the surface, as the American population gets older..

According to the JAMA study, there will likely be a profound increase in knee surgeries over the next 15 years. The researchers who conducted the study believe that by 2030, there could be 3.5 million knee replacements per year. That’s up from “only” about half a million procedures in 2010. (It’s like an old bad joke, about counting up the number of knees, and dividing by two to get the number of people.)

Multiply the $15,000 per surgery by millions of new procedures, plus inflation, and we’re talking about some real money, even by government standards (of course, as it is now, Medicare already takes another 2.9 percent of everyone’s income right off the top as payroll taxes).

“Replacing the replacement” is becoming disturbingly commonplace

There are two types of total knee replacements:  primary and revision. Revisions occur when a primary knee replacement fails or wears out. This “replacing the replacement” surgery is now much more common because primary knee replacement procedures are being done before they’re really needed, and at increasingly young (and inappropriate) ages.

Out of the 3.3 million people in the JAMA study who had a primary knee replacement, about 10 percent subsequently had to have revisions. That’s more than double the amount there were 20 years ago.

So why is this happening? I have a theory.

Hospitals are pushing patients out the door earlier and earlier, whether or not they are ready to go home. Twenty years ago, the average length of hospitalization after knee replacement surgery was eight days. Today, it’s just four days.

Perhaps this “short-sheeting” of hospital patients helps account for the skyrocketing numbers of revision knee replacements? Not to mention lining surgeons’ pockets.

Another thing to take into account is that a significant percentage of total knee replacements are performed by surgeons who do fewer than 12 of these types of procedures per year.2 On the one hand, you can’t accuse these surgeons of running knee replacement “mills.” But on the other hand, maintaining skill and proficiency—as well as appropriate surgical and operating room capability and hospital support—may be better done with more practice. (Then again, 12 knee replacement surgeries per year, at a cost of $15,000 each, still comes in quite handy with those monthly yacht and fancy foreign car payments.)

Medicare bureaucrats are discussing whether more knee replacement procedures should be shifted to high-volume surgery centers. These centers have lower readmission rates following primary knee replacements, plus lower rates of revisions.

But there are much more important matters that aren’t even being considered. Namely, how to avoid these unnecessary surgeries in the first place.

Natural ways to protect your knees

One reason we have an epidemic of knee problems is because too many aging amateur marathon runners and “weekend warriors” got swept up in an exercise craze that pushed them beyond reasonable limits for joint health (or even heart health). They now “require” joint replacements, according to orthopedic surgeons.

But do they really?

We rarely hear from orthopods about the appropriate use of natural joint supplements. Most of the “natural-know-it-alls” are no better, pushing supplements like glucosamine and chondroitin that simply don’t work.

But taking the right doses of the right nutrients works remarkably well in a relatively short time. There have been many single-ingredient studies showing how the plant-based supplements boswellia, ashwaganda, and turmeric reduce joint pain and restore joint function.

While each of these nutrients is effective alone, studies show that they’re most potent when used together. In fact, as I reported in last month’s Insiders’ Cures, the boswellia/ashwaganda/turmeric combo relieves osteoarthritis pain better than prescription drugs like Celebrex.

Another benefit: When this supplement trio is taken together, you may need significantly lower doses.  I know people who have had remarkable results on a fraction of the single-ingredient doses of these three marvelous joint remedies. One man I know was even able to tell his surgeon to cancel his knee replacement!

The latest research and clinical observations show that minimum effective daily doses of my recommended joint “triple play” are 270 mg of boswellia gum extract, 300 mg of ashwaganda root extract, and 120 mg of turmeric root. Of course it is safe to take higher doses (up to double), and you may need these higher doses if you have a larger body or a bigger skeletal frame size.

I know at least one man who was able to cancel his knee surgery after taking these combination doses for just 3 months.

Vitamins and minerals are also important for bone and joint health. I recommend  500 mg of vitamin C a day, 50 IU of vitamin E, 150-200 mg of magnesium, and 5 mg of boron.

And of course, vitamin D is a must. I recommend 5,000 IU of vitamin D3 daily for everyone for general health (especially at this time of year), and particularly for bone and joint health.

Finally, daily exercise will help keep your knee joints supple and your bones healthy. But there’s no need to go to extremes. Walking, yard work, and housework are all good, sensible approaches that are a lot easier on your joints than running on hard pavement or gym floors. Swimming and any kind of movement in water is also ideal for joints, as well as for general health.

Instead of shelling out billions of our tax dollars for useless and dangerous knee replacement surgeries, perhaps the powers-that-be at Medicare should pay more attention to these scientifically proven, highly effective natural approaches. The solutions are all so obvious…except to those who profit most from being oblivious to them.

Your healthy knee checklist

My recommendations for maintaining healthy joints—and avoiding knee surgery—are as follows:

  • 270 mg of boswellia gum extract
  • 300 mg of ashwaganda root extract
  • 120 mg of turmeric root
  • 500 mg of vitamin C
  • 50 IU of vitamin E
  • 150–200 mg of magnesium
  • 5 mg of boron
  • 5,000 IU of vitamin D3

Take these nutrients each day. And don’t forget to get some light physical activity on a regular basis too.


1Cram P, et al. Total Knee Arthroplasty Volume, Utilization, and Outcomes Among Medicare Beneficiaries, 1991-2010. JAMA. 2012;308(12):1227-1236. doi:10.1001/2012.jama.11153.

2Slover J, Zuckerman JD. Increasing Use of Total Knee Replacement and Revision Surgery. JAMA. 2012;308(12):1266-1268. doi:10.1001/jama.2012.12644.