Barbara J. Friend RN, BSN * Director of Health

Your choice of doctor and hospital matters most.  But it's also wise to ask about device safety and whether newer techniques are right for you. 

You might think that knee and hip replacements would be an everyday affair.  After all, they're among the most common operations in the U.S., with about 1 million done every year.  And with that number set to quadruple by 2030 they look to be practically a rite of passage into the golden years.


But that popularity has not bred consensus among surgeons.  The choice of prosthetic, the operating procedure and more can vary from one surgeon or hospital to the next.  And that variation can have important impact on outcomes.  One example:  Your chance of post-surgical infection.  Consumer Reports found striking differences in infection rates even among hospitals in the same area.  St. John's Health Center in Santa Monica, Calif;' for example, rated well(68 percent better than the national average for knee infections); nearby Los Almitos Medical Center earned an extremely poor rating (122 percent worse than the national average).


Here's what else matters most;


In an era when your options include 3D printed knees and robotic surgical assistants, the doctors experience still matters most.  "It is hard to find a more powerful predictor of outcome than volume" says Jeffrey N. Kutz, M.D., Director of the Orthopedic and Arthritis Center for Outcomes Research at Brigham and Women's Hospital in Boston.   In most hospital" there's somebody who is spending a lot of time doing replacement, Katz says.  "That is the person you want" A hospital's experience matters too.  Those with the most experience tend to have support staff who can help manage pain, speed recovery, and watch for trouble.


Ask prospective surgeons how many replacements they have done in the past year (ideally, you want someone with at least 50), and about complication rates (look for 3 percent or less infection rate, too (It should be lower than 1 percent) and it's rehabilitation plan.  A Hospital that gets patients moving soon after surgery cuts and risk of complications and hastens recovery)


Joint replacement has seen astounding advances in recent years in the types of prosthetics available and the techniques by which they are implanted.  Some hospitals pitch 3D-printed implants that promise a tailor-made fit or robotic-assisted procedures that allow "minimally invasive" surgery requiring smaller cuts and less drilling in bone.  But the jury is still our on such advances, so far only a small number of surgeons opt for either.  "They sound cool" Katz says "but there's no evidence that they're any better than what we've been doing for ages."  What is more, they may end up in a poor-quality hospital with a poor-quality surgeon because they offer the one gadget you think you need."



Of course, you should still ask some questions.  Implants are often allowed on the market without review by the Food and Drug Administration, says Lisa McGiffert, Director of Consumer Reports Safe Patient Project.  And all major knee and hip manufacturers have had a product recalled in the past decade" she says.  When an implanted device is recalled, the cost of replacing it is often borne by patients and their insurance, not the device maker.  The revision tend to cost more and be less successful than the original.  It can also result in longer Hospital stays and additional surgeries beyond the revision.  McGiffert argues that knee and hip implants should come with a warranty.  Until they do you should do your homework.


Ask whether the device the surgeon uses has been recalled at any point, and if so, why?  It is not a silly question, McGiffert says.  Recalled devices are sometimes used.  You should also find out what the device is made of.  They are usually made of metal alloys, ceramics or plastic) and ask for device documentation, including the manufacturer model name, and product insert.  Keep the information with your medical records.

Reference *Consumer Reports on Health, 

November 2016, Volume 28 Issue

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