Knee and hip replacements are now among the most common operations in the U.S.
With about 1 million performed every year and quadruple that number expected by 2030, it’s practically a rite of passage into the golden years.
Yet despite its growing popularity, the procedure has no set standards or techniques.
Among other things, the choice of device (or “prosthetic”) and the operating procedure can vary from one surgeon or hospital to the next. And that variation can have an important impact on outcomes.
One example: your risk of a postsurgical infection.
“Your chances of developing an infection after knee replacement can vary substantially depending on which hospital you go to,” says Doris Peter, Ph.D., director of the Consumer Reports Health Ratings Center.
“When we took a close look at hospitals in California, for example, we found striking differences among hospitals even in the same area,” she adds.
Here’s what else matters most:
Doctors and hospitals
In an era when your options include 3D-printed knees and robotic surgical assistants, the doctor’s experience with the type of surgery still matters most.
“It’s hard to find a more powerful predictor of outcome than volume,” says Jeffrey N. Katz, M.D., director of the Orthopaedic and Arthritis Center for Outcomes Research at Brigham and Women’s Hospital in Boston.
In most hospitals “there’s somebody who is spending a lot of time doing replacements,” Katz says. “That’s the person you want.”
A hospital’s experience matters, too. Those with the most experience tend to have support staff that 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).
Check on the hospital’s infection rate, too (it should be lower than 1 percent), and its rehabilitation plan. A hospital that gets patients moving soon after surgery cuts the risk of complications and hastens recovery.
Procedures and prosthetics
Joint replacement has seen astounding advances in recent years, in the types of prosthetics and in the techniques used to implant them.
Some hospitals pitch 3D-printed implants that promise a tailor-made fit. Or they recommend robotic-assisted procedures that allow “minimally invasive” surgery requiring smaller cuts and less drilling in bone.
But the jury is still out 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’s more, they may be more expensive.
If you’re considering surgery, avoid being swayed by the newfangled.
“You shouldn’t focus too much on the technical details,” Katz says. “If you do, you may end up in a poor-quality hospital with a poor-quality surgeon because they offer the one gadget you think you need.”
Recalls and revisions
Of course, you should ask some additional 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 tends 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’s not a silly question, McGiffert says: Recalled devices are sometimes used.
• Find out what the device is made of. They’re usually made of metal alloys, ceramic, or plastic.
• Ask for device documentation, including the manufacturer, model name, and product inserts. Keep the information with your medical records.
I’m a scientist-turned-journalist, covering the intersection of science, policy, and consumer health. I have an abiding passion for good storytelling and verifiable data. I live in Manhattan with my husband and our cat. When I’m not working, I love museums, parks, and visiting my people in New Jersey. Follow me on Twitter (@JInterlandi).