How to Choose the Right Surgeon for Your Joint Replacement
When it comes to planning your joint replacement surgery, there are a lot of moving parts and decisions to be made. For many, one of the major decisions is choosing the right surgeon to perform their hip or knee replacement. Although many end up going with the orthopaedic surgeon recommended by their primary physician, more and more patients are playing an active role in finding the man or woman who’ll implant their new joint.
As we’ve said before, we truly believe that knowledge is power. Doing some digging on a prospective surgeon is performing due diligence that we recommend all patients carry out. Investing time into learning more about your recommended surgeon will either offer peace of mind or encourage you to meet with other surgeons that may be a better fit.
After all, as a patient, you have more choice than ever when it comes to finding a qualified, board-certified surgeon. With that, not all surgeons are created equal. Here’s what you should look for when choosing the ‘right (wo)man for the job’.
1) Surgeon’s Baseball Card Stats: Complication Rate and Case Load
Looking at the complication rates of a surgeon is one of the most important things you can do before moving forward. As a hip or knee replacement candidate, you have full access to this information online. Unlike most procedures, there is mandatory Medicare data collection for joint replacement surgery and this data is readily available.
The data collected shows each surgeon’s complication rates and case loads. This information can be found on ProPublica under the “Surgeon Scorecard”. Simply type in your prospective surgeon’s name and you can see their adjusted complication rate and how many hip or knee replacements they’ve performed. If you see a low number of cases and a high complication rate, this is a red flag.
Ideally, your surgeon will have completed a high number of cases with a low complication rate. Keep in mind that Surgeon Scorecard data may be dated (from 2009-2013), so newer surgeon’s may not show up in search or have full statistics available.
2) Do You Have Any Specific Needs?
Although two surgeons may be equally qualified to perform a successful joint replacement, one surgeon may specialize in something more closely related to your needs. For example, one orthopaedic surgeon may perform more replacements on younger athletes while another specializes in patients with secondary conditions like diabetes or rheumatoid arthritis.
In an interview with Karen, a recent knee replacement recipient, she discussed how important it was that her surgeon had a dual interest in both orthopedics and arthritis. Having underlying Ankylosing Spondylitis, Karen explains her choice of University of California San Francisco Medical Center (UCSF) and her surgeon, “I liked the idea of arthritis doctors and othopedists working together since I had this underlying Ankylosing Spondylitis. With this, I knew I wanted UCSF, which is ranked number 7 in orthopedic surgery and has an arthritis and joint replacement clinic.”
If your joint replacement is more complex than average, finding a surgeon that has a special focus on your additional risk factors is a smart move. For example, if you have a metal allergy, working with a surgeon who has experience with ceramic components makes sense. Another example: If you’re overweight, working with a surgeon who has experience performing the procedure on someone with a higher BMI (obese is 35+) may make more sense for you.
Find a surgeon that is tailored toward your individual needs.
3) Look at the Hospital’s MRSA Rate
Each hospital has an MRSA (Methicillin-resistant Staphylococcus Aureus) rate. MRSA is a bacterium that causes infections in different parts of the body. Higher MRSA rates mean higher rates of patient inflections and surgery complications. You want your surgery to be performed at a hospital or centre that has low rates of MRSA. The MRSA rate for each hospital can be uncovered with some digging.
Dr. Chabner, MD and Radiation Oncologist, who recently underwent a hip replacement explains, “A lot of hospitals have flashy names and well-known physicians but also have a lot of MRSA. The rate of MRSA at a hospital is important to know---this knocked out hospitals and physician groups I would have otherwise considered.” In other words, when narrowing down her own search for a surgeon, Dr. Chabner dug beneath the veneer of “big name” hospitals and looked into less marketable characteristics.
This is a great resource to learn more about MRSA infection and to reveal if a hospital you’re considering has a high rate of it.
4) Be Practical and Businesslike
In a conversation with Dr. Chabner, she shared a physician’s perspective on selecting a surgeon. In this, she cycled back to one thing in particular: the importance of being practical and businesslike when choosing a surgeon. For Dr. Chabner, the importance of selecting a surgeon based on their skill far outweighed anything else. Like in the workplace, this can sometimes mean putting bedside manner or likeability aside to go with the most skilled person for the job. Dr. Chabner explained that hip replacement surgery “is a very technical procedure, so I needed someone with a skill-set. I wasn’t worried about the doctor-patient relationship.”
Dr. Chabner added that, “everyone is going to have a bad story from every surgeon”. It’s better to focus on actual things like MRSP rate, complication rates or case load numbers. As Dr. Chabner says, “the numbers don’t lie”. Be comfortable with a surgeon’s skill, and then take into account the “extras” like bedside manner. Since it’s such a technical procedure, skill should far outweigh personal connection.
5) Willing to Travel?
Are you willing to travel for a “better” surgeon? Depending on a number of factors (like health risks or financial reasons), travelling to another city, state or even country can be a logical decision.
Increasing numbers of patients who aren’t properly covered by insurance in the US are travelling to countries, like India, for their joint replacement surgery. Although there are obvious risks in doing this, for many, this the best choice available. Similarly, travelling within the US to another state to get a less expensive replacement is gaining popularity.
Companies like United Airlines even offer cheaper joint replacements to employees willing to travel to Chicago’s renowned Rush Medical Centre.
On the other end, those with wider coverage that allows them to go with an out-of-region surgeon may choose a top-rated physician that they must travel to. If traveling for the right surgeon is something you’re considering, note that flying within 4-6 weeks after surgery is not recommended due to an increased risk of blood clots. It’s vital to take this into account as it may affect your recovery location.
6) Who’s Covered by Your Insurance?
Insurance coverage will likely play a major role in the surgeon you end up going with. With the hefty price tag of joint replacement surgery, going with a surgeon that isn’t covered by your healthcare insurance isn’t an option. With that said, there should be a lot of surgeon choice within your plan. This is especially true if you’re in a PPO plan where you have the freedom to choose any medical facility or provider.
Karen, who heavily researched her surgeon and hospital, said that she switched to a PPO so that she could go with her choice medical provider (University of California San Francisco Medical Center).
Switching health plans is a bit of a logistical and paperwork nightmare so triple-check that this is something you want to do. In most cases, there is a surgeon within your network that you’re comfortable with and ticks most of your boxes.
7) Ask Around!
Word travels along with reputations. Hit the interwebs and do some friendly Google searching on a surgeon you’re considering. You can read interviews they’ve done, check out any reviews, find a social media page etc. You can also check out websites like RateMD.com and search any reviews on our doctor. It’s not uncommon for a doctor to not have any reviews or to only have a couple. Keep in mind, as Dr. Chabner pointed out, that reviews like this (especially online) do not fully represent a physician. Online reviews tend to lean on the extremes--very happy people leave reviews and very unhappy people leave them as well.
Turning to your medical team is another great place to turn to for more insight. Ask some of the nursing staff or the Director or Nursing questions like: “If you needed this surgery, would you have Dr. XYZ do it? Would you send a loved ones to this surgeon? Are there other surgeon’s in the area you’d recommend as well? The nursing team may not flat out say that they wouldn’t go with the surgeon you’re considering, but they may give you something to chew on.
Lastly, ask your surgeon for references. Although this may sound unusual, it is actually common practice. A great surgeon will have a roster of patients who are happy to detail their experience with you. Talking to your surgeon’s patients gives you an opportunity to ask questions and hear honest feedback.
By researching your surgeon, our hope is that you feel both empowered and confident in who’s performing this life-altering surgery. With an increased emphasis on patient satisfaction and more tools available to find a great surgeon, finding a provider that checks your boxes is more possible than ever. Do the research today and have more peace of mind on surgery day.
Are you preparing for surgery? Have you heard of PreHab to get in the best physical and mental shape before a joint replacement? It’s game-changing. Sign-up for PeerWell’s PreHab program to learn more.