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Data-Driven Consideration of Joint Replacement Surgery

Posted Jul 07 2010 12:00am

Various types of medical registries (e.g., cancer, drug, prosthesis) are becoming critical elements for assessing the quality of healthcare. This applies to physicians and patients alike (see: Saving Lives with Web-Based Patient Registries for Patients with Chronic Diseases ). Part of the conversation with one's orthopedic surgeon should involve the type of prosthetic device that he or she recommends. Of great interest is that an artificial joint registry will soon be available on the web that gathers data directly from U.S. hospitals about these devices. Similar data is already available from other countries. Presumably, healthcare consumers will have access to this new U.S. registry after it is created. You can refer to a recent article for many more details about how to "get it right the first time" regarding joint replacement surgery (see: Getting a New Knee or Hip? Do It Right the First Time ). Below is an excerpt from it

In the United States in 2007, surgeons performed about 806,000 hip and knee implants (the joints most commonly replaced), double the number performed a decade earlier. Though these procedures have become routine, they are not fail-safe. Implants must sometimes be replaced,....A study published in 2007 found that 7 percent of hips implanted in Medicare patients had to be replaced within seven and a half years. The percentage may sound low, but the finding suggests that thousands of hip patients eventually require a second operation....Those patients must endure additional recoveries, often painful, and increased medical expenses. The failure rate should be lower, many experts agree. Sweden, for instance, has a failure rate estimated to be a third of that in the United States. Sweden also has a national joint replacement registry, a database of information from which surgeons can learn how and why certain procedures go awry. A registry also helps surgeons learn quickly whether a specific type of implant is particularly problematic. “Every country that has developed a registry has been able to reduce failure rates significantly,” said [a noted orthopedic surgeon]. A newly formed American Joint Replacement Registry will begin gathering data from hospitals in the next 12 to 18 months.

When interviewing potential orthopedic surgeons prior selecting one, a reasonable question for patients to ask is how many times he or she has performed the particular operation, their success rate, and the frequency of the procedure in the hospital where it will take place. One way to ferret out the surgeon's success rate is to ask what percentage of implants had to be replaced and when. Practice may not make perfect but it sure helps, as illustrated by another quote from the article cited above:

A study published in The Journal of Bone and Joint Surgery in 2004 found that patients receiving knee replacements from doctors who performed more than 50 of the procedures a year had fewer complications than patients whose surgeons did 12 procedures or fewer a year. The researchers documented a similar trend when it came to hospital volume. Patients at hospitals that performed more than 200 knee replacements a year fared better than patients at hospitals that performed 25 or fewer.

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