Best practices for OS to diagnose and recommend a THR

[dlp]

Sadly, in the US, our system doesn't make getting full statistics easy. It's really sad, but I think our system tends to encourage NOT making this data public because it interferes with profits.

ProPublica does some great work, but their numbers are mainly based on records from Medicare, because they are publicly funded. I think they are also a few years behind. Checkbook does what it can with surveys of patients, and I think even surgeons. But that data depends on people actually taking the time to participate.

Interestingly, my hospital has hired a company to survey me about my experience, but every time they decide to call me it seems I'm busy doing something else. Ironic since I really don't have a very full calendar right now. But the moral of the story is that even though I've asked, they won't let ME call THEM to participate. I imagine this is more common than not.

Better than no data - hopefully these orgs can keep pushing for more and better!

 

[Mojo333]

I attribute my good fortune with surgeon and hospital to mostly luck.
My doctor referred me to Optim orthopedic center where the surgeons there deal mainly wwith joint replacement and several doctors own the surgery center where they perform these.
Not only was the infection rate much lower than the national average...the staff were well trained in dealing with aftercare, etc.
Trust in the surgeon is key.
All the risks can't be alleviated but I did very well.

 

[anny]

Was the decision to go with THR as simple as you make it sound?

I don't think 'simple' is the word anyone would use for the decision to have the op.....when I was first told it was my best option, I meekly agreed to it, being in a haze of disbelief. I had a 6mth wait for the op and, as with many people, my hip could perform quite painlessly for days at a time, I would talk myself into believing that it was really not that bad and should I do something as drastic as a THR. Then, of course, it would suddenly show its ugly side and I'd be wishing the op was Now, if not yesterday. It was a complete roller coaster during the wait, almost up to the day of the op. Now I'm booked in for No 2, and I should be confident in my decision, having done it before, but my hip has been almost 'normal' again, and I'm still second guessing myself about the op. In my heart of hearts I know it needs doing, but we are so skilled at kidding ourselves....I am a black belt at it

 

[Eman85]

These links are more useful for our purposes:
https://www.checkbook.org/surgeonratings/Hip-or-Knee-Replacement-Surgery/CA/?Page=1

https://projects.propublica.org/surgeons/state/CA/procedure/8151

MY OS only has 3 stars in the checkbook rating, glad I didn't see any of this pre-op.

 

[Jaycey]

@SelfHelp I'll give you another perspective on waiting. I waited over 3 years for my LTHR. I assumed the pain I had was lower back issues and I had a spinal surgeon who agreed. It was only when my hip collapsed that I got the diagnosis.

Hips can go from tolerable to horrid literally overnight. Sounds like your life has already narrowed greatly. Life is too short. Find a surgeon you can work with and get your THR. You won't regret it!

 

[dlp]

MY OS only has 3 stars in the checkbook rating, glad I didn't see any of this pre-op.

Mine only has 2, but both of my surgeries went great. Until they get total data, I consider these things to be more akin to Yelp or TripAdvisor (DocAdvisor? ) - another tool in the belt.

It's sad that you can get restaurant health ratings easier than you can get a rating of surgeons or physicians. (for instance: https://services.sccgov.org/facilityinspection)

 

[SelfHelp]

I am planning to get a recliner (lift chair) for the post-op recovery period. Do you know if healthinsurance would pay for part or all of it? Appreciate any suggestions or recommendations.
I am not a back sleeper and will need that recliner to get some sleep as well as keeping the leg up.

 

[SelfHelp]

Jaycey soon after my post here that my hip actually was not that painful, it decided to act up and make my life miserable. Walking has become quite painful suddenly. Is it time?

 

[SelfHelp]

dlp I use those links to find the high volume and low complication doctors. In my mind those are the 2 most important criteria. You agree? BTW, are you using a recliner during your recovery?

 

[dlp]

dlp I use those links to find the high volume and low complication doctors. In my mind those are the 2 most important criteria. You agree? BTW, are you using a recliner during your recovery?

Hi @SelfHelp! I don't disagree that those 2 things are important. Doing more surgeries should make someone a better surgeon. Volume is good, as long as you don't feel like you are being passed through an assembly line

However, I do feel that not all decision making should be done using those sites exclusively. I wouldn't just pick a surgeon based on those numbers alone. For instance, the ProPublica data is based on Medicare results, and they acknowledge in their methodology section that this is a limitation. If a surgeon does mostly private insurance cases, it's completely possible that they could have a significantly different complication rate, to the good or the bad end of the scale. Not saying it's bad data - just saying it's limited data, and should be treated with a little scrutiny just like anything else.

As for recliner, I've not used one for either surgery. My wife and I are sort of anti-recliner anyway - we've never owned one, and don't really want to start now
For just sitting, I bought a raised cushion (basically a wheelchair cushion) to put under the cushion of an armchair for my first surgery. It helped me avoid sinking into the chair and breaking restrictions. For my recent surgery, I had no restrictions after 1st week - but am still using a (different) cushion just because it makes getting in and out of the chair easier while I wait for my iliopsoas to get itself back into shape.
I know some folks use them for sleeping. But for me, I slept on a wedge pillow in bed to keep me mindful of not rolling over on my incision (I'm mainly a side sleeper). After that, I slowly started sleeping normally, some on my back, sometimes on the non-op side (with a pillow between the knees, of course).

 

[SelfHelp]

Any advice on having healthinsurance pay for recliner?
I am planning to get a recliner (lift chair) for the post-op recovery period. Do you know if healthinsurance would pay for part or all of it? Appreciate any suggestions or recommendations.
I am not a back sleeper and will need that recliner to get some sleep as well as keeping the leg up.

 

[Eman85]

I really don't see the need for a lift recliner unless you need one now. Don't see why health insurance would pay for one. I'd be more interested in an icing machine like a polar pack. I'm not a back sleeper but it's amazing how you'll learn to sleep on your back post op for a week or 2.

 

[Jaycey]

Walking has become quite painful suddenly. Is it time?

Only you can say when it is time. But if your world is already narrowing due to hip pain I would get this THR done. Your hip will never get better and can only get a whole lot worse. Planning your life around hip pain is just no fun. Get your THR and get on with living again.

 

[SelfHelp]

Have seen so many posts on how useful a recliner is during initial weeks of the recovery, for just resting during the day and sleeping when sleeping on your back becomes painful. Our bedroom is on the 2nd floor, all comfortable seating on 1st floor are too low and soft and will break the 90 degree rule. To rest or take a nap I'll need to take the stairs; not looking forward to that. That is why I decided to get a recliner. With a lifting recliner there is no chance of breaking the 90 degree rule.
Am I making too much of the precautions and dislocation risk? Eman85 and dlp, you guys somehow managed; you must have ways of resting during the day without risk.

 

[Mojo333]

I loved my recliner

 

[dlp]

Our bedroom is on the second floor as well. I didn't find stairs to be too much trouble to navigate a few times a day - and during the first day or so, I spent most of the time sleeping, icing and elevating - so the bed was good for all of that. Also used a couple of big pillows to prop me up when I felt like sitting up and reading or whatever. Important point here, though, is to not live in the bed. Gotta get up and move, and visit other parts of your house so that you don't get into the mindset that you are sick/ill.

For sitting in our living room to watch some TV, I use our armchair, but propped the cushion up with a 3" thick heavy duty foam wheelchair cushion. It's a thick foam that didn't squish up. Just scooted on and off to sit or stand, and the height allowed me to do it without breaking 90º.

Also, don't fret too much about the 90º thing. Yes, you want to heed restrictions, but a little slip to 95º or 100º isn't going to dislocate. I think the overall percentage that I've seen is something around 2% in the first year. My surgeon has told me both times that in the past several years using the implant he uses that he's had 0 males dislocate, usually attributed to larger bone and muscle structures, and the larger femoral head sizes used for men.
I was super paranoid about breaking the 90º rule after my first surgery, and I'm sure I accidentally broke that restriction at least half a dozen times. I'm not saying you should bend over and touch your toes - but if you do happen to go beyond 90º a little bit, you'll generally be OK. Just don't make it a habit

I had a shorter restriction period this time around than last time - basically just 1 week for hip #2 as opposed to 4+ for hip #1. My surgeon seems to be joining a growing number that don't impose, or impose fewer, restrictions than in the past. But since my leg was pretending to be a log for the first few weeks after this most recent THR, I mostly kept up with the restriction routine for a while anyway since I wasn't ready to go out dancing, and it was more comfortable

If you think the recliner will work for you, cool. I just didn't feel the need for the extra expense (and as I noted my wife and I really don't like them as furniture anyway). My mom has one, and it's pretty sweet. Has made her life a lot easier, so I see the appeal.

 

[Jaycey]

don't get into the mindset that you are sick/ill

Excellent point - you will be fully mobile when you leave the hospital including going up and downstairs on your own. I didn't have a recliner post both THRs and had no problem. A firm pillow or cushion on any "soft" furniture works very well.

 

[SelfHelp]

Thanks for the dose or reality dlp. Maybe I did get carried away with the recliner idea. I was planning on selling it after the recovery. Looked for cushions on Amazon, found these two, since I am tall, over 6' I'll probably go with the 6" high one.

 

[SelfHelp]

dlp, I believe your surgeon uses the Stryker ADM which I understand has better range of motion than traditional prosthesis; with better range of motion you have less dislocations.
Based on my reading on bonesmart I believe that risk of dislocation is mainly due to non-optimal position of the acetabular cup, read "surgeon's skill". Not sure how much larger acetabular cup and ball helps with dislocations.

 

[dlp]

dlp, I believe your surgeon uses the Stryker ADM which I understand has better range of motion than traditional prosthesis; with better range of motion you have less dislocations.
Based on my reading on bonesmart I believe that risk of dislocation is mainly due to non-optimal position of the acetabular cup, read "surgeon's skill". Not sure how much larger acetabular cup and ball helps with dislocations.

Yep - I'm now the proud owner of 2 Stryker ADM X3 prosthetics. Kind of a shame that I can't show them off considering how much they cost. I guess the X-rays will have to suffice

As for the dislocation, I don't really know all of the science behind it, just that I've seen that a few articles mentioning that there is a slightly higher risk in women because of the smaller femoral heads. I imagine ultimately health, weight, muscle mass, strength, prosthesis and surgeon skill all play enough of a part that you can't specifically point to 1 thing.

https://www.physiciansweekly.com/total-hip-arthroplasty-gender/
https://www.cbsnews.com/news/hip-replacements-more-likely-to-fail-in-women-says-study/
https://www.ajrr.net/images/annual_reports/AJRR_2016_Annual_Report_final.pdf
https://www.ajrr.net/images/annual_reports/AJRR-2017-Annual-Report---Final.pdf (these mention that larger heads offer increased stability - but don't break anything down by gender - I figure that probably also translates into less dislocation possibilities. It also mentions that dual-mobility is seeing an increase in usage presumably because of better stability and reduced dislocation chances)