How can I avoid dislocating my replaced hip?

I am having hip replacement surgery. How can I decrease my chances of dislocating my new hip?

Be careful about where you have the surgery–and who does it. A recent study looked at the results of 59,000 Medicare patients 90 days after surgery. The number of hip replacements done by hospitals and surgeons made a difference in patients’ results. Patients were less likely to dislocate the new hip when they had surgery in hospitals that did a lot of hip replacements. Patients whose surgeons did a lot of hip replacements also had fewer dislocations.

There is no “magic number” of surgeries per hospital/surgeon that will guarantee your new hip. The number of complications goes up as the number of surgeries goes down. Happily, dislocations are rare (three percent in one study). Talk with your doctor about the measures you need to take after surgery to protect your new hip.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

How rare is it to have rheumatoid arthritis and need a hip replacement?

I have rheumatoid arthritis in my hips and will probably have one of them replaced in the spring. I’ve gotten the impression that we are fairly rare and that most patients who need hip replacements have the other kind of arthritis. Just how rare is my situation?

Keeping track of number and type of joint replacements can be done in several different ways but in the United States, we don’t have every patient entered into a database like some other countries do. We can get information from hospital discharge data and Medicare part B that is helpful. Many times, this is limited to patients over the age of 65. It doesn’t include younger patients or people who have their replacements done in private orthopedic surgical clinics.

Some of the other countries such as Finland do have a national registry. This type of information is routinely collected and has been a clinical feature for over 30 years. Because their patient population isn’t so different from ours (socioeconomic, educational background, lifestyle), we can often make comparisons that could easily apply to our country.

A recent report was published using data from the Finish Registry that might answer your question. They ran a software program that pulled out how many hip replacements were done just for patients with rheumatoid arthritis. The time period information was collected from was from 1980 to 2006. There were a total of 132,540 primary (first-time) hip replacements in the whole study (all diagnoses such as osteoarthritis, traumatic arthritis, rheumatoid arthritis). Breaking that down by age, the majority of those (86 per cent) were in adults 55 years old or older. That’s approximately 114,600 of the 132,540. And of the people in the 55 years and up group, only five per cent (about 6,000 patients) had rheumatoid arthritis as their main diagnosis. So you can see, this isn’t a rare group but fairly uncommon. Those overall figures are lower than in the United States where over half a million hip replacements done each year. About five per cent of those will be in patients with a primary (main) diagnosis of rheumatoid arthritis (RA). With the new, more effective medications to control the progression of joint destruction associated with RA, this percentage may not increase over time — even though more adults with RA are living longer with their disease. Over time, better control will yield better results and outcomes with less invasive treatment.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Is it possible to predict who will and who won’t have a good result from a total knee replacement?

My father-in-law is going to have a total knee replacement next week. Call me a pessimist but I think he’s going to have problems. He’s old (83 years old) and frail. Is it possible to predict who will and who won’t have a good result?

Researchers are studying many problems patients face with the idea of predicting who will have a good/poor result. The hope is to give the right care to each group to get the most benefit.

When it comes to total knee replacements (TKRs), there are quite a few studies already done on this topic. One of the most recent ones looked at over 200,000 patients who had a TKR between 1991 and 2001. Rates of infection, blood clots, and death were compiled. Factors such as age, gender, health, and type of insurance were matched against the data.

They reported that age over 65 was a risk factor for problems. Likewise, patients with more than one other health problem had worse outcomes. High blood pressure, diabetes, and a previous history of blood clot(s) are all risk factors for problems after surgery.

Previous studies have shown that surgeon experience makes a difference. Surgeons who do more TKRs have the best results. It turns out that hospitals have similar track records. High volume hospitals have the lowest death rate and rate of infection after TKRs.

Your father-in-law’s best chances for a good recovery depend on his health, his surgeon’s skill, and the type of hospital he will be staying at. Type of insurance seems to have an impact, too. Medicare patients have worse results than patients covered by private insurance.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.