High-tech

When we originally - that would be last November - discussed this surgery with Dr. Smith, we found him to be a vigorous advocate of a computer-assisted laser-driven positioning device, whereby the new implant could be set in exactly straight to within a millimeter, level with the ground in all dimensions. This is best, I was assured, and that sounds sensible to me.

I had assumed that all the top-notch people were now doing it this way (as opposed to the previous system of jigs plus instinct), but apparently not. My physical therapist was puzzled by the two little holes in my thigh and also on my lower leg, and asked if they were drains or something. No, I said, that's where they mounted the lasers to signal this positioning system. She sees a lot of knee replacement folks, and she'd never seen this before.

I did a Google search, and this thing has been around at least since 1995, though most of the articles on it are in expensive medical journals where you can't get at them.

My surgeon is in love with this thing. He claims it's revitalized his entire practice, and this enthusiasm explains that big grin in the OR. I can see that. Not only does he get to play with a lot of very jazzy equipment, he now has the tools to get a much better result more reliably.

God alone knows, of course, what the equipment costs. [Note: today (1/29) I found out what it costs. The software comes in at $400,000; they "give" you the hardware with the software. There must be some reason for this odd pricing; I'm suspecting some tax reason. The software, like all software, is subject to update, for another fee, of course. Not really as much money as I thought.] Somehow someone or other talked Mills Peninsula Hospital, a tired old hospital (more on this later), into springing for this thing. I am told that knee replacements are big money-makers for hospitals, at least compared to the uncompensated care they're required to provide to a lot of people (anything's a profit center compared to that!), and since patients like me have a lot of alternatives about where to go for this surgery, and indeed, whether to have it at all (it's "elective" surgery, your other choice being to be in constant pain I guess), having the Snazziest Equipment is doubtless intended to be a selling point.

I'm not qualified to evaluate any of this. That's what I hired the surgeon for. If he says it's better, and if the proposal doesn't offend common sense, then I go with that.

Again, cost. Are they going to hit me or Blue Cross or both of us up for being yet again on the cutting edge? Well, yeh. Of course. The only question is, where will this expense be hidden in the bill, and what would the alternative cost?

And what am I willing to pay for a shot at a better result? Name your figure, people. Anything even remotely within reason.