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Why it's Important to Get a Second Opinion Before Undergoing Joint Replacement Surgery

Since 1997, I've evaluated and worked with about two dozen people who have had knee or hip replacement surgeries. A few have reported having better quality of life following joint replacement surgery, while the majority have reported experiencing more difficulties than they did before having surgery.

If you have a severely deteriorated joint that prevents or significantly hinders basic activities of daily living, I think that joint replacement surgery is an option worth considering. But I think it's critical to do two things before undergoing surgery:

  1. Do everything possible with your dietary and lifestyle choices to reduce strain on the deteriorated joint(s), namely:

    • If overweight, strive to get lean for your structure.

    • Follow a predominately plant-based diet that is rich in healthy fats and low in animal protein.

  2. If you cannot improve your situation within a reasonable amount of time by working on your dietary and lifestyle choices, be sure to get a second opinion before opting for surgery, and check to see if the orthopedic surgeons that you consult with have financial ties to companies that manufacture artificial joints.

Checking for financial ties between orthopedic surgeons and joint makers is important, as history tells us that the highest profit margin - not the model that best suits each patient's needs - is what determines the choices that some orthopedic surgeons make for their patients.

In 2007, a United States Department of Justice investigation revealed that many orthopedic surgeons received substantial "consulting fees" for using the paying company's artificial joint products. Five of the top artificial joint makers in the United States were charged with criminal conspiracy to violate anti-kickback laws.

The companies involved escaped criminal prosecution by agreeing to a settlement that called for 18 months of federal monitoring. Zimmer Corporation, DePuy Orthopaedics (a division of Johnson & Johnson), Smith & Nephew, and Biomet Orthopedics agreed to pay $311 million in fines. Stryker Orthopedics avoided a fine by being the first company to cooperate in the Justice Department's investigation.

So how do you check for financial ties between the surgeons you visit and the joint makers mentioned above? By visiting the joint makers' Web sites, where, as a part of the settlement, they provide lists of their consultants' names and how much their consultants have been paid. The companies are required to keep these lists published on their Web sites until March of 2009.

Look for the section on "Compliance," or "Company Consultants - Identifications and Payments" at the following sites:

Zimmer Corporation - Click on "Company Consultants - Identifications and Payments at the top of the site.

Smith and Nephew - Look for the section on "Compliance" at the lower right section of the site.

DePuy Orthopaedics - Click on "DePuy Orthopaedics" to get to another site that has a section on "Company Consultants."

Biomet Disclosure Page

Stryker Consultants Page

Robin Young, publisher of Orthopedics This Week, had this to say about the settlement between these companies and the Justice Department:

"The dollar figures were a little higher than expected, but this is being viewed as a speeding ticket for these companies."

Mr. Young went on to say that the government might now turn its attention to smaller companies that manufacture artificial joints, as the smaller companies typically have extensive financial relationships with their doctor customers.

Again, if you have a severely deteriorated knee or hip joint, and you don't feel hopeful about improving your situation with your diet and lifestyle, I believe that it is worth your while to consider joint replacement surgery. By doing some research using the Web sites referenced above, you should be able to find an orthopedic surgeon who will help pick the best artificial joint device for your situation.

Please share this article with family members and friends who may be considering joint replacement surgery. Thank you.


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I am a sales rep for one of your mentioned orthopaedic co.'s. I want to be sure that the message to patients is NOT that anyone who has a consulting agreement is only concerned with the money that goes in their pocket. Many of these surgeons have done considerable research and development for the entire orthopaedic industry. They are the most knowledgeable and experienced surgeons. When you are having this type of surgery you want someone who is familiar with the product and has a full understanding of how it works. I am so afraid that the recent stories on the relationship between joint surgeons and manufacturers are misleading to the public. There are some non-legitamate arrangements out there but not all should have this stigma. All companies small and large have consulting agreements only the large ones have been forced to these disclosures at this point. Please encourage your readers to make sure their surgeon knows the product he is working with well and that the product has a good clinical track record. The relationship a surgeon may have with a company should not be the reason someone looks else where for care.

Thank you.