May 2012

Flying can be trying: Most hip implants trigger security delays

In the moment: Surgery #2375800

By Samantha Rosenblum 

Researchers in Baltimore reported that patients who have undergone total hip arthroplasty may experience greater inconvenience than other passengers when going through airport security.

In the study, published in April in The Journal of Bone and Joint Surgery, 143 patients with hip replacements who had traveled by air in the last year were surveyed about their experiences going through security checkpoints. Of these patients, 120 reported triggering the alarm a mean of four times, 25 patients reported having to undergo further inspection, and 99 indicated that the prosthetic joint caused an inconvenience.

“Patients with hip replacements should expect some degree of delays the greater majority of the time. For the most part, it’s not going to be a terrible inconvenience,” said Michael Mont, MD, an author of the study and director of the Center for Joint Preservation and Replacement at the Rubin Institute for Advanced Orthopedics in Baltimore.

The findings were consistent with those of an earlier study from the same group on patients with total knee arthroplasty, published in the February issue of the Journal of Arthroplasty.

The researchers noted that such inconvenience is typically reduced when the patient is carrying an implant card either from the implant manufacturer or their surgeon that identifies them as a recipient of a prosthetic joint. In the hip implant study, only 18 of the 109 patients who had a card and triggered the alarm had further checks performed after the required wanding. By contrast, seven of the 11 patients who did not have a card and triggered the alarm underwent further checks. Mont explained that having a card is the most effective measure patients can take against such inconvenience.

“It’s probably a good idea to have identification that lets somebody know that they have a joint replacement,” Mont said. “It may not get rid of the checks at airports, but it may reduce the time that they spend being evaluated. There’s an occasional patient that really gets a tremendous body search and is terribly inconvenienced, but for the most part, those patients did not have an identification card on them.”

“TSA recommends that passengers advise an officer at the security checkpoint if they have a medical device or other travel concern,” said Tess Hawkins of Transportation Security Administration’s public relations.

TSA has worked with disability and medical condition advocacy groups in efforts to understand the needs and concerns of individuals with disabilities and medical conditions. In 2007, TSA began using advanced imaging technology, which the organization says is preferred by passengers with joint replacements or other medical devices that typically set off a walk-through metal detector. Millimeter wave or backscatter imaging is used at approximately 170 airports to screen passengers safely without physical contact for metallic and nonmetallic threats that could be concealed under layers of clothing. Some survey respondents in the Baltimore study noted that the use of full-body scanners has reduced the inconvenience they experience.

Previous studies have found that the likelihood of detection can be influenced by walking speed through the detector, the side of the implant in relation to the detector, the detector’s sensitivity, and the metallurgical composition of the implant. In the Baltimore study, almost every patient surveyed had cobalt, chrome, or titanium implants, Mont said.

Patients with additional prostheses may be more likely to experience delays. According to the study, patients with two hip prostheses had a significantly higher detection rate than patients who only had one.

Additionally, patients who have undergone total hip arthroplasty should expect to encounter similar security procedures in settings other than airports. Forty nine participants reported triggering alarms at both airports and a second location, including courthouses, federal buildings, and retail stores. –SR


Johnson AJ, Naziri Q, Hooper HA, Mont MA. Detection of total hip prostheses at airport security checkpoints: how has heightened security affected patients? J Bone Joint Surg Am 2012;94(7):e441-e444.

Naziri Q, Johnson AJ, Hooper HA, et al. Detection of total knee prostheses at airport security checkpoints. J Arthroplasty 2012 Feb 23. [Epub ahead of print]


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