What I didn't get is that the article seemed moderately well researched - they highlighted many of the absurdities in how the pricing system works. But they then focused on the element of the cost which is not the major driver of the difference between a foreign surgery and a domestic one, and made some pretty unfounded statements about the technology as well. I guess they just wanted to be able to blame Zimmer et al? (I also love how they ignore the very reasonable critique of the PPACA excise tax on medical devices without much discussion.)

I can speak from personal experience (I have worked in orthopedic biomaterials for the last 7 years) - joint replacement technology has advanced by leaps and bounds from the relatively primitive implants used in the past. Most of it is necessity - in the absence of good therapies for osteoarthritis and cartilage defects, surgeons desperately need implants that will work in younger and younger patients. Old school hip/knee total joint replacements work for a healthy 75 year old, since you figure that (1) their activity level is lower, so the number of load cycles (and likely their intensity) will be lower, and (2) they aren't likely to outlive the implant (also 3: they have healthy enough bone turnover - e.g. no osteoporosis - that they'll get good implant integration). But doing the same to a 50 year old is a recipe for disaster - requiring multiple revision surgeries at shorter and shorter times in a vicious cycle. So the joint replacement companies have had to do some pretty fancy innovation in materials design to improve the longevity of their implants.

The underlying technologies are quite sophisticated. For example, a lot of effort has gone into reducing wear and wear particles - lots of people have played with material design and manufacturing techniques to make a bearing surface for hip implants that will last much longer than older technologies, which much fewer wear particles to affect the implants and the biology (I actually just reviewed a promotion application for one of those evil academic/clinical scientists who's taking money from these companies and helping improve people's lives). Implant loosening is also a significant issue, especially because of potential long-term issues with tissue/material interactions at the surface and poor osseointegration. There's intensive research into different coating technologies that will enhance implant integration with the surrounding bone (though personally I'm less convinced that much of the work done here has really solved this problem yet).

The point is that there is a lot of new technology coming on board on a relatively frequent basis, and while it's probably irrelevant for a run-of-the-mill elderly patient, it's absolutely critical for the faster growing age groups (mostly 40s and 50s). Some innovations work better than others, true, and that's why we have clinical research - to catch ineffective treatments as they get rolled out on a larger scale and for a longer time than is possible for clinical trials. The orthopedics companies haven't been sitting on their asses, twiddling their thumbs, and watching the big bucks roll in.

I have no doubt there's plenty of room for savings - for one, having older functional designs be used for uncomplicated cases, for another fixing the byzantine procurement system. There have also been issues - as with most device/pharma companies - with sales reps getting a bit too chummy with physicians. The largest driver of overall costs, though, has little to do with the actual device pricing and far more to do with our dysfunctional hospitals and billing/insurance systems.