Knee & Hip Replacement: How To Pick a Good Surgeon
A dear friend is planning knee replacement surgery and asked me who I recommended. Here’s the hitch: she doesn’t live in this country but she is willing to travel here for the surgery and stay for basic recuperation. So here’s how I went about helping her.
What I wanted first and foremost was a hospital that specializes in this type of surgery or at least does a large volume of this type of surgery. US World and News Report is a great place to start and their results are published on line. The report is separated into specialty areas, so in this case I chose orthopedics.
The hospitals reviewed are all experienced in treating difficult cases and qualify for inclusion in the report only if a certain volume is reached or if surveyed specialists recommended the hospital.
The rankings are based on the following:
- Reputation with physicians
- Relative death rate
- Patient safety
- Patient volume
- Level of nurse staffing
- Nurse magnet status
- Technology score
- Patient services score
- Trauma center
The relative death rate is a ratio that compares the number of medically complicated patients who died within 30 days of their hospital stay with the number of deaths expected after adjusting for severity and other risk factors. The lower the better.
Patient safety rates the number of medical errors and accidents from 1 to 5. Again, the lower the better.
Patient volume is important because again, you want a hospital that has a high volume of the type of surgery you need. This number is derived by looking at the number of patient discharges in the particular medical speciality (in our example, orthopedics). Anything greater than 2000 is considered high volume.
Level of nurse staffing is actually the patient to nurse ratio – again the lower the ratio, the better patient care you can expect.
Nurse magnet status is a sign of excellence awarded to a hospital by the American Nurse Credentialing Center.
Technology score denotes whether the hospital uses the up-to-date technology for orthopedic surgery.
Patient services score denotes the number of other ancillary services available for this particular specialty – the higher the number the better.
How to Select a Surgeon
Once you’ve narrowed down the hospital, the next thing is to find a good surgeon. Essentially, you want someone who specializes in the type of surgery you need. I usually recommend that people talk to their friends, relatives and other medical providers. When you ask a medical professional, ask him or her who they would want to operate on their own family member.
Don’t be afraid when meeting with the surgeon to specifically ask how many surgeries s/he has performed in the past year. Studies show that surgeons who do 50 or more replacement surgeries a year generally have fewer post-op complications.
Some hospitals keep registries that track knee and hip implants that are associated with higher than average revision rates. Talk to your surgeon about the kind of implant that would best serve you and what problems are associated with that particular device.
The NYTimes published a great article entitled, “Getting a New Hip or Knee? Do It Right the First Time” by Leslie Alderman. I highly recommend reading it for further tips on selecting a surgeon.
As for my dear friend, the hospital I recommended to her was Hospital for Special Surgery, in NY, NY. It’s an orthopedic hospital close to her family and is rated #2 in the country (Mayo Clinic was #1). I wasn’t able to recommend a surgeon – that’ll require some interviewing on her part, but the hospital publishes a list of ortho surgeons who specialize in knee replacement.
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