For the vast majority of patients with debilitating knee pain, joint replacement surgery is considered an “elective” procedure.

While it’s true that one’s life doesn’t depend on it, what about quality of life? Many people hobbling about on painful knees would hardly regard the surgery as optional. Consider, for example, two people I know: a 56-year-old man passionate about tennis who can no longer run for a bus, let alone on the court, and a 67-year-old otherwise healthy woman with bone-on-bone arthritis who can’t walk without a cane or stand for more than a few minutes.

They have reason to think it may be time to replace their worn-out knees with artificial ones, an operation that is now among the most frequently performed costly medical procedures in the United States. But some leading medical economists are asking whether this surgery is being done too often or too soon on patients who have not adequately explored less invasive approaches to relieve their pain and improve their mobility.

I certainly had done due diligence before opting to have both knees replaced 14 years ago at age 63. I had wanted to wait longer, given that the life expectancy of artificial knees was then 10 to 15 years, and I would have liked Medicare to help foot the bill. I had no weight to lose and had done months of physical therapy that made me stronger but not better. I tried gel injections to no effect, and was living on anti-inflammatory drugs just to get through the day.