Medically reviewed by Susan Kerrigan, MD and Marianne Madsen on February 8, 2023
Additions/comments provided by Matthew Russo, MD – Orthopedic Surgeon
The sensitivity of airport security screening measures has increased substantially during the past decade, but few reports have examined how this affects patients who have artificial joints. Over 90% of implanted total hip and knee arthroplasty devices will set off airport metal detectors. With varying levels of security in airports worldwide, as well as varying clearance provided by TSA Precheck or Clear, patients with a new joint may set off the detector in one city but not another. Joint replacement surgery is increasingly in demand as national healthcare systems confront an ever-aging population. This in turn is having an effect on air travel; more specifically, unwanted and significant inconvenience caused to travelers going through airport security.
To understand this phenomenon better, a study was conducted with a sample of 250 patients who presented to the office of a high-volume surgeon. These patients were asked whether they had had a hip prosthesis for at least one year and, if so, whether they had flown on a commercial airline within the past year. Patients who responded affirmatively to both questions were asked to complete a written survey that included questions about which joint(s) had been replaced, the number of encounters with airport security, the frequency and location of metal detector activation, any additional screening procedures that were utilized, whether security officials requested documentation regarding the prosthesis, the degree of inconvenience, and other relevant information.
Of the 143 patients with hip replacements who traveled by air, 120 (84%) reported triggering the alarm and required wanding with a handheld detector. Twenty-five of these patients reported subsequently having to undergo further inspection, including additional wanding, being patted down, and in two cases having to undress in a private room to show the incision. Ninety-nine (69%) of the 143 patients reported that the prosthetic joint caused an inconvenience while traveling.
In another similar study that was designed to characterize the efficacy of airport metal detection of total knee prostheses, the delays faced, any inconvenience this may have caused, and the role of implant identification cards, ninety-seven total knee arthroplasty recipients reported passing through an airport metal detector, with 70 triggering the alarm a mean of 3 times (range, 1-36). The presence of a single-knee prosthesis triggered airport security alarms more than 83% of the time and increased patient inconvenience. Patients should be informed about this chance and be prepared to present documentation of their prosthesis.
According to the American Society for Hip and Knee Surgeons, a card or note from your physician is not needed for identification of these types of implants. However, based on a study examining the effects of the increase in air travel for aging patients, looking specifically at the effect of artificial joints on travel, both airport security officers and patients concluded that joint replacement implant identification cards streamline airport security checks and decrease the need for more invasive searches at airport security.
However, even with such a note, a traveler may still experience some level of inconvenience and should be cautioned beforehand to prepare in advance for travel delays and to give themselves extra time at the airport. If a person has a metal implant, it is advisable to inform the Transportation Security Administration (TSA) officer before screening begins that you have had a hip or knee replacement and to point to the location of the implant. Passengers can use the TSA’s Notification Card to communicate discreetly with security officers if they prefer. Telling the TSA officer or showing this card will not exempt a passenger from the screening. Instead, the passenger will be instructed to go through the body scan machine. Many people prefer to be screened by the body scan to reduce the likelihood of a pat-down being necessary. Because of the necessity for airport security, it is likely that passengers with artificial joints will experience more inconvenience when travelling. In order to ease discomfort, it is recommended that security personnel be informed in advance.