At age 56, Doug Sauer’s left hip was shot. He felt nearly constant pain from his left thigh to his ankle, and once-routine movements could be excruciating. X-rays taken by his primary care provider showed he needed a hip replacement; his cartilage was virtually gone from wear and tear. Sauer, who’d toiled as a construction superintendent and worker, feared that his plans to retire and move from Fairfax County, Virginia, to a rural area of North Carolina and build a dream timber-frame retirement home would be physically impossible.
Sauer’s fears vanished hours after his morning hip replacement surgery at MedStar Georgetown University Hospital in Washington, D.C., in early 2015. By mid-afternoon the same day, Sauer was on his feet. “With a cane, I was going up and down steps, walking through the hallway,” he says.
When your bad hip — from a medical condition, trauma or the wear and tear of aging — is threatening to bring on constant pain and disability, hip replacement may be on your radar. While no one looks forward to undergoing an operation, the good news is that hip replacement surgery has become routine and is typically highly effective, says Dr. Brian G. Evans, chief of the division of adult reconstruction at MedStar Georgetown. Evans operated on Sauer.
How to Choose a Surgeon for Hip Replacement Surgery
Such a specialist might do more than five joint replacements a week, many of those hip surgeries. Outcomes are typically better with hip replacements done by specialists who perform such surgeries regularly. “If you go to someone who’s doing it routinely, they have a system in place at the hospital, in the operating room,” Evans says. “It’s not like you’re doing a new operation every time.” A hip replacement specialist would likely have an anesthesia team experienced with providing regional anesthesia. This typically involves providing a spinal anesthesia that makes the patient numb from the waist down.
If you’re looking for a hip replacement surgeon, here are six questions you should ask:
— What are your complication rates?
— What is hip function like for most of your patients six months after surgery?
— How do you measure patient satisfaction?
— Which surgical approach do you specialize in?
— Is it possible to go home the same day following total hip replacement surgery?
— How long should I expect my new hip to last?
What are your complication rates? A hip replacement is a common surgery, and complication rates for physicians who do them routinely should be well below 4%, Evans says. Infection rates should be below 1%.
Complications following joint replacement surgery can include surgical and medical issues, says Dr. Nader A. Nassif, division chief of joint replacement at Hoag Orthopedic Institute in Orange, California.
Surgical complications include:
— Infections of the new joint.
Medical complications include:
— Deep venous thrombosis.
— Pulmonary embolism.
— Heart attack.
— Urinary tract infections.
— Gastrointestinal irritation from the blood thinners used.
What is hip function like for most of your patients six months after surgery? Patients of a successful hip replacement should feel dramatically better six months after the operation, and often much sooner. Compared with other types of operations, hip replacements provide patients with a greater change in their perception of their improved health than other surgeries, such as a bowel resection or an organ transplant, Evans says. For example, patients who were functionally disabled with arthritis can resume a wide range of physical activities — like playing tennis or walking vigorously — after a hip replacement. It won’t take long for some patients to forget they’d once been hobbled by a bad hip. “When you have a good hip replacement, it just feels like a natural part of you,” he says.
How do you measure patient satisfaction? Many hospitals and health care groups — including MedStar Georgetown — survey patients to measure patient satisfaction, Evans says. “We survey patients randomly eight to twelve weeks (after a surgery),” he says. “We collect data on short-term outcomes, such as readmissions, infection and repeat surgeries,” Evans explains. “We also collect data on patient satisfaction. This information is used to modify and improve the protocols and pathways we follow in treating our patients.” Most doctors follow patient outcomes.
What surgical approach do you specialize in? There are two major approaches to hip surgery: anterior and posterior. “Both approaches work very well and are known to have equal functional outcomes,” Evans says. The anterior approach has become much more popular in the last five years or so, Evans says. Ten years ago, about 5% of surgeons used the anterior approach; today, about 40% of hip replacement surgeries are conducted with this approach.
With the anterior approach, the muscles remain intact. Surgeons stretch them and pull them out of the way rather than cutting tendons and repairing them. Patients who undergo the anterior approach tend to rehab more quickly and experience less pain in the first several days after the surgery. In the early days of post-surgical recovery the anterior approach may be associated with less pain, Evans says. It’s important to keep in mind that some hip problems can be more difficult to address from an anterior approach. Talk to your surgeon about what approach is best for you.
Is it possible to go home the same day following total hip replacement surgery? Yes, says Dr. Michael B. Gerhardt, a sports medicine specialist and orthopedic surgeon at Ceders-Sinai Kerlan-Jobe Institute in Los Angeles. Just a few years ago, many doctors would have their patients stay in the hospital for several days following hip replacement surgery, he says. Advancements in surgical techniques and technology have changed that. “Our ability to perform the surgery in a less invasive manner affords us the opportunity to send patients home safely and comfortably soon after their procedure,” Gerhardt says. “Smaller incisions, less blood loss and expedited physical therapy allows patients to get up and comfortably walk within hours after surgery.”
How long should I expect my new hip to last? The vast majority of hip replacements will last two decades, according to the American Association of Hip and Knee Surgeons. Most data on the outcomes of hip replacements suggest that hip replacements have an annual failure rate between 0.5% and 1%. “This means that if you have your total joint replaced today, you have a 90-95% chance that your joint will last 10 years, and a 80-85% that it will last 20 years,” according to the association.
You can also research your surgeon’s background on independent sites like SurgeonRating.org and ProPublica’s ” Surgeon Scorecard.” U.S. News also ranks the best hospitals for hip replacement surgery using data on patient survival, nurse staffing, volume and more.
Look for a high-volume facility — one that regularly performs these procedures. Depending on your location, choices can range from major medical centers to facilities that concentrate on hip and knee conditions.
Cost may be a consideration, too. Citing information from Blue Cross Blue Shield of North Carolina, CostHelper.com, a consumer information startup, estimates the cost of a hip replacement will be close to $40,000 for someone without insurance. And while most insurance companies cover the procedures, patients who have a hip replaced may still pay several thousand dollars in out-of-pocket expenses. Costs vary depending on region and other factors.
Preparing for Your Hip Replacement Surgery and Recovery
After you choose a surgeon, the National Library of Medicine suggests you ask these questions about hip replacement surgery and how it will affect you:
— How well does this surgery work for someone my age and with any of the medical problems I have?
— Will I be able to walk without pain? How far?
— Will I be able to do other activities, such as golf, swimming, tennis or hiking? When can I do them?
To prepare for your operation, make sure your health care providers are up-to-date about health status, including:
— Medical conditions.
— Complete list of medications.
Find out how side effects will be managed in your case, and what precautions you’ll need to take post-surgery. For instance, ask how long you’ll wear compression stockings after surgery to prevent embolisms (blood clots) and what sort of anti-clotting medicine you’ll receive.
Ask about sports activities and when you can resume them. (Most activities are fine after hip replacement, but many surgeons advise against running or jogging.) Also, ask how you can prepare before surgery to make the outcome more successful — such as learning to use crutches or a walker before you actually need them, and how to manage stairs. And talk to your doctor or physical therapist about how to get in the best possible shape before surgery, to make recovery easier.
Also ask about your surgical wound care and supplies. For instance, your physician may recommend you don’t immerse yourself in water — a Jacuzzi, bathtub or pool — during the first few weeks until the wound is healed.
Life After Surgery
Sauer spent just one night in the hospital following his surgery. Some patients are transferred to a rehabilitation center for physical therapy, but Sauer went straight home. He engaged in outpatient physical therapy for about a month.
On a scale of 1 to 10, Sauer says, his pain was about a 6 during the first two days, but dissipated quickly. “I used a cane during the first week, and I really had zero pain after that first week.”
About eight weeks after surgery, Sauer was back to full activities — teaming with his wife, Catherine, to build their dream house and hiking and kayaking with her. Other than hiring a carpenter, Sauer and his wife did everything. “I dug the foundations, framed the structure, put the roof on, did the plumbing and electrical,” he says. “We put the cabinets in. We put in concrete counter tops. I would certainly recommend it to anybody who needs it.”
Now retired, Sauer, 66, has zero qualms about the prospect of having his now-ailing right hip replaced. “I have no anxiety,” he says. “After my first hip replacement, my life was instantly better.”
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Update 05/13/21: This article was previously published and has been updated with new information.