What Every Patient Needs to Know to Ensure the Best Outcome for Hip and Knee Replacement

As a patient considering medical tourism for hip or knee replacement your goal should be to obtain the best possible outcome.  The best outcome, a long lasting, pain free hip or knee that allows you unlimited activity without perioperative complications, is what you should be seeking.  What are the ingredients that increase the likelihood of this outcome?

The Facility

Ideally, the center should specialize in orthopedic care.  It should be designed for a high volume of cases with the highest standards.  Ask about the infection and complication rates and how this data is obtained.  As in most things, practice makes perfect.  Selecting a facility that performs a high volume of orthopedic surgery ensures that the systems are in place for these specialized procedures.

The Surgeon

Seek a board certified surgeon whose practice focuses on hip and knee replacement (Adult Reconstruction).  This surgeon should perform at least two-hundred fifty (250) hip and/or knee replacements annually.  Surgeons who practice at this volume level or higher, and who have at least ten (10) years of experience, have a lower complication rate.

Pain Management

There has been great progress in pain management techniques for hip and knee replacement.  It is rare for patients to suffer from the typical side effects of narcotic medications such as nausea and sedation.  Our goal is rapid recovery for safe and early return home and we have tailored our medication regimes to allow patients to be fully awake without pain in the recovery room within minutes of the completion of surgery.  We rarely use intravenous narcotics now; instead pain is well managed with pills alone.

The advances in pain management developed by surgeons and anesthesiologists have been a key part of rapid recovery and improved experience for the patient.

Nursing Care

Critically important, but often overlooked, is the quality of nursing care provided.  After the patient leaves the operating room, the experienced nurse is the key provider of care within the critical first twenty-four hours, and the nurse is usually the first to observe any possible problems.  Intelligent and responsive nursing is a key factor in a safe surgical outcome.  Specialized care plans devised for joint replacement aids in rapid recovery.

The Implant

Today’s surgeons have a myriad of implants to choose from for hip or knee replacement.  The experienced high volume surgeon who reads, understands, and often participates in the research regarding these implants is the best person to choose the implant components for you.  The implant manufacturers have flooded the internet with infomercials backing their products.  The experienced, well read surgeon sifts through scientific literature and bases his or her choices on evidence, not on hype.  Surgeons should make an individual choice of implants based on that patient’s own situation.  Cost of the implant should not factor in the decision, scientific evidence should drive decision making.  Ask your surgeon about why they choose the specific implant they use.

It is critically important for patients to know that all implants and procedures are not alike.  Most low volume surgeons are not adept in less invasive hip or knee replacement.  Lower cost implants usually lack the latest advances in design that often can lead to dramatic increases in implant component longevity.  An implant choice can mean the difference between a revision surgery in ten years or up to twenty-five years.

Finally, while no one wants to consider the possibility of a complication, one should think about how a complication would or could be managed.

As they graduate from medical school in the US, newly minted doctors repeat the Hippocratic Oath.  One of the key phrases is “first do no harm”.  While saving a few dollars is quite alluring to patients today, they would do well to repeat this phrase in their mind when researching hip and knee replacement.

James Caillouette, MD, is a board certified orthopedic surgeon who specializes in hip and knee replacement.  He is the immediate past president of the California Orthopedic Association, a former director of the American Association of Hip and Knee Surgeons and he is Chairman of Newport Orthopedic Institute.  He works at the Orthopedic Surgery Center of Orange County, a new member of the Medical Tourism Association.

Quotes:

Surgeons who practice at this volume level or higher, and who have at least ten (10) years of experience, have a lower complication rate.

There has been great progress in pain management techniques for hip and knee replacement.