THR Choosing a hip surgeon

[Bangeduphip]

Hi all,
I have begun research to choose a surgeon for my up coming hip replacement surgery and have a few questions. I live in Wisconsin and am looking at two possible surgeons but I am open to other suggestions. Both surgeons would do the Anterior approach. Options I have looked at are:
1) Richard Berger, he is very highly rated and advertises minimally invasive surgury where he does not cut muscles, ligaments, or tendons. His nurse said there are no post surgery restrictions after recovery from surgery is complete. He also says patients are back to work in a very short time period. He advertises that his minimally invasive technique allows the hip to heal more completely and feel more natural.
2) My local hip replacement surgeon. He also comes highly rated and I have met with him a few times over the past few years. He does a high volume of hip replacement surgeries. He said the only restriction after recovering from surgery is no running.
He said prepare to be off work for possibly 4 - 6 weeks after surgery.

Dr. Berger is out of network for my insurance but his surgical center is in network. That could mean thousands of dollars of extra cost. This would also require me and my wife to drive almost 2 hours each way for the surgery.
My local Dr. Is in network and a 20 minute drive.
I am 50 and very active so avoiding post surgery restrictions is important to me with balancing longevity of the hip implant. Here are my questions:

1) Are all Anterior approach hip replacement surgeries minimally invasive with avoiding cutting muscles, ligaments, and tendons, or is that specific to Dr. Burger?
2) Are post recovery restrictions just the opinion of the doctor or are they a reflection of two doctors performing the surgery differently?
3) How do I get information regarding a doctor's infection rate and number of Anterior hip replacement for younger (50ish years old) patients? Is it possible to get this information?
4) Are their other Dr's. in Wisconsin that perform the minimally invasive hip replacement surgery, like the one Dr Berger does.
5) Do people usually stay in network for a surgery like this?

Just trying to figure out if the differences in how the surgery is performed warrent paying quite a bit extra. Any other information you could provide would be greatly appreciated. Thank you.

 

[djklaugh]

@Bangeduphip Welcome to BoneSmart! I will try to answer some of your questions. First - there really is no "minimally invasive" surgery for a total hip replacement. This is major surgery no matter which approach is used and your body will need time to recover from it. AND no matter what approach is used muscles, tendons, etc are NOT cut! They are moved aside (retracted) so surgeon can access the hip capsule so they do get a bit traumatized but that trauma is usually very minor and heals well.

Restrictions after hip replacement do vary from surgeon to surgeon --- I had both hips replaced at once (called a bilateral procedure) and when my surgeon discharged me he said my only permanent restriction was "NO bungy cord jumping!" ... and I was 64yo then.

As for finding out a surgeon's infection rate -- not sure where you'd find that information. Hospitals and surgical centers do report post op infections to their licensing boards and the state. You might be able to ask surgeon or his nurse or assistant about that and about how many younger folks surgeon treats.

IMO if I were you I'd stay in your insurance network not just to save money but also for continuity of care - easier to get to return appointments and IF -as occasionally happens -- you needed further surgery or treatment for a problem, you have an easier time getting that care. I have HMO insurance and even if I had the money I would not consider going out of network for any kind of care.

Alas I am in Oregon and have no information about surgeons in your area. You might check with your insurance to see who else they have on their provider list. Other members here may have other information about surgeons they will share with you. In the mean time here is our list of pre op articles and suggestions:

Hip: pre-surgery considerations

If you are at the stage where you have joint pain but don't know for sure if you are ready to have surgery, these links may help:


Score Chart: How bad is my arthritic hip?
Choosing a surgeon and a prosthesis
BMI Calculator - What to do if your surgeon says you're too heavy for joint replacement surgery
Longevity of implants and revisions: How long will my new joint last?

If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:


Recovery Aids: A comprehensive list for hospital and home
Recliner Chairs: Things you need to know if buying one for your recovery
Pre-Op Interviews: What's involved?

And if you want to picture what your life might be like with a replaced hip, take a look at the posts and threads in stories of amazing hip recoveries

 

[Layla]

Hello and Welcome to BoneSmart! Thanks for joining us, Bangeduphip!
Below you will find is an explanation of surgical approaches, including visuals.
THR approaches or incisions

I experienced the posterior approach with no restrictions other than to move mindfully / slowly and if anything caused pain...STOP.

I will also add that we recommend a Phased Return to Work at 12 weeks - Phased return to work
Surprisingly, many surgeons convey unrealistic timelines for recovery in their initial consultations. Please keep that in mind. You will likely find confirmation of that through reading here. Most members do not have the strength or stamina to return to work at four or even six weeks post op. Naturally it depends upon what demands are placed on you in the workplace, but I would not count on the ability to return to work that soon. Also, once you return, your colleagues automatically assume that YOU'RE BACK and ready to perform as before.

I will tag Admin to check their resources for surgeons in your area @Jamie so check back periodically.
I wish you the best as you research surgeons. Stay in touch, we're here for support always.

 

[Eman85]

Restrictions are a term thrown around, really no big deal in recovery and not a bad thing if you want a good recovery. It makes sense not to strain the hip capsule and soft tissue in the first weeks of recovery. 4-6 weeks and back to work is the total optimistic prediction of recovery for a desk worker, generally 12 weeks for a comfortable return to work for most. Minimally invasive, another catch phrase in the THR jargon. No matter how it's done when you think about what is actually done to us there is no way it's minimal.
My OS was in network for both my THR's and 2 different insurance policies. I traveled 2 hrs and stayed overnight at the hospital, also stayed overnight the night before at a motel near the hospital to make the early surgery easier.

 

[trailrunner]

I saw two doctors before I decided to proceed.

The first doctor I saw was overall negative. I think in her mind she was trying to manage expectations, or maybe she was constrained by the large HMO she worked for. She told me that after the surgery no running (she actually got mad when I asked her about it and almost refused to do it at that point), and limited biking. Plus lots of other limitations.

The second doctor I went to was much more positive. He has done 6,000 hip replacements for a well-known local orthopedic clinic. Two people (husband and wife) from my tennis club had hip replacements from him and spoke highly of him. He told me that I would not have any long-term restrictions. I specifically asked him about running, and he said that would fine. He said the modern cross-linked polyethylene (a fancy plastic) liners last a long time, and that he has never had to replace one ("they just don't wear out"). What I liked about his answer is that it was based on his experience and actual data. He is also very experienced, so I trust his judgement more than the first doctor I saw.

The issue with running is that it might wear out the cup liner faster. I did some amateur literature review, and I couldn't find anything conclusive either way. I think some doctors just repeat general and conservative guidelines that are safe, but don't necessarily have empirical evidence behind them. Note that you might have a choice of liner - metal (not used too often from what I understand), ceramic, and plastic. Ceramic is supposed to have the very lowest wear rate, but isn't used too often (again, from what I understand). The plastic is the most commonly used and the modern versions have a very low wear rate.

Caveat: I am not an orthopedic doctor.

 

[AlanInAZ]

Choosing between two surgeons based on long term activity restrictions is really meaningless. Neither gives a money back guarantee. With the direct anterior approach the prosthesis is essentially the same for both surgeons and assuming both position the prosthesis correctly then the long term risk is the same. Neither surgeon knows how much running will shorten the prosthesis lifetime since there is no real world data for 30 plus years with the modern plastics. Lab simulations exist that show good long term potential but once in the body there are biological processes that could shorten useful life. In my case I have stopped all high impact activities to protect the implants that I have. That is a personal choice.

In my mind surgeon skill is the criteria for selection. You make the choice how you will use your new hip and what risk is acceptable.

 

[Bangeduphip]

Thank you all so much for your replies. I gained lots of wisdom. Sounds like I need to find the most skilled surgeon. Any help with that would be much appreciated. I live in Wisconsin, half way between Green Bay and Milwaukee. Also, if anyone has advice regarding the best materials to use for the liner (if I get that choice), that would also be helpful. Thank you to everyone for your the time and advice.

 

[Freyagirl]

I just had both hips done 8 weeks apart. Anterior with no restrictions, no cut muscles etc. BUT also no claims that I would be totally healed so quickly. The surgery can’t be done without a significant incision, bone cutting, major trauma to tissues and muscles. It takes time to get healed and more time for bone to grow to hold the new hip firmly. Please don’t go into the surgery or choose your surgeon based on unrealistic expectations. Read the information on this site to help you get a better idea of actual recovery times. I hope it will help you as it has me.

 

[AlanInAZ]

best materials to use for the liner

There is a short comedy routine by Steve Carell on late night TV show in which he satirizes his experience with a direct anterior hip replacement. One of the laughing points was the selection of liner material. After a discussion on the operating table with the surgeon Carell got a ceramic liner and for laughs he demonstrated how it squeaks. You can find it on YouTube.

 

[Chessie]

1) Are all Anterior approach hip replacement surgeries minimally invasive with avoiding cutting muscles, ligaments, and tendons, or is that specific to Dr. Burger?

Perhaps it is specific to the doctor, but not sure. I was back in the gym 2 weeks and 2 days, after both of my replacements. (7 years apart for each hip, same surgeon). I rode 18 miles on the gym cycle the first night back at the gym. I was running 3 months after the first one, the second one took longer. I do still run though only short distances. Nothing like I used to. I did not have any restrictions at all after my 2 weeks was up. But I was a very active person - spending hours in the gym and running/biking. I'm sure that makes a difference.

2) Are post recovery restrictions just the opinion of the doctor or are they a reflection of two doctors performing the surgery differently?

Possibly. I had anterior with both of mine.

3) How do I get information regarding a doctor's infection rate and number of Anterior hip replacement for younger (50ish years old) patients? Is it possible to get this information?
4) Are their other Dr's. in Wisconsin that perform the minimally invasive hip replacement surgery, like the one Dr Berger does.
5) Do people usually stay in network for a surgery like this?

I honestly had not even looked at the network thing until I had already chosen my surgeon. Thankfully he was in network.

 

[benne68]

I live in Wisconsin, half way between Green Bay and Milwaukee.

Would you be willing to travel?

 

[Jamie]

Unfortunately, I don’t have any surgeon recommendations for the state of Wisconsin. You didn’t give your local surgeon’s name, so I’m unable to do that research. But I did look at Dr. Berger and he would be someone I would consider for a consultation, if the costs and distance driving are acceptable for you.

I’ve asked our CEO, who works routinely with surgeons all over the US, if he has any surgeon names for Wisconsin and hope he’ll be able to respond soon.

As another member mentioned above, you want to search for a good, experienced surgeon rather than worrying about the approach, implant materials, or promises of “quick” recovery. Doctors usually go with whatever procedures they were taught during their school and training. There is no “best” implant. Any surgeon you consider should be doing at least 150 hip replacements (not hip surgeries) per year. If the surgeon also indicates he does hip revisions or reconstructive hip surgery, that is a plus when you’re getting a primary THR (not that you’ll need a revision, but revision specialists usually have a higher level of skill and are aware of what post-op problems can occur).

 

[Bangeduphip]

Thank you all so much for your replies. I gained lots of wisdom. Sounds like I need to find the most skilled surgeon. Any help with that would be much appreciated. I live in Wisconsin, half way between Green Bay and Milwaukee. Also, if anyone has advice regarding the best materials to use for the liner (if I get that choice), that would also be helpful. Thank you to everyone for your the t and advice.

 

[Bangeduphip]

Thank you again to everybody for your time and information. I am obviously new at this. Much appreciated. My local orthopedic Dr is Dr Charles Green. Another Dr. in my area is Dr. Michael Schnaubelt. Any information on those two Dr.s and how they compare to Dr Berger would be much appreciated. I have heard good things about all of them but I am not sure how to research their skill levels. I am also willing to look into other options if needed and I would travel for surgury if needed.

 

[djklaugh]

@Bangeduphip It certainly is wise to seek out the best, most experienced surgeon to do your surgery. However I would seriously urge you to check with your insurance before signing on with any surgeon. Do be sure that not only is the surgeon's care covered but also the hospital or surgical center he/she uses. It's not just the cost of surgery or care at a facility that is a concern. IF any part of the surgical process is "out of network" then the insurance company might refuse to pay for other things - such as return follow up visits, medications prescribed, physical therapy if needed. And, heaven forbid! If you had any complications and needed any additional surgery or treatment, the insurance company could refuse to pay for that as well.

I have HMO insurance and also worked for that company for 24 years. You need to check not only is the surgeon in network but also do you need a referral to see a surgeon? Some companies do require that you have a specific referral to a specific provider in order for any treatment to be covered.

Yes you want the best for your procedure and you do not want to end up with a humongous bill!

 

[Bangeduphip]

Thanks again for all the replies. I have done lots of research. Still not sure how to figure out yhe best hip replacement surgeon. Any feedback on the surgeons I mentioned previously or info on a different surgeon in my area would be much appreciated. Thanks again.

 

[Jamie]

Thank you again to everybody for your time and information. I am obviously new at this. Much appreciated. My local orthopedic Dr is Dr Charles Green. Another Dr. in my area is Dr. Michael Schnaubelt. Any information on those two Dr.s and how they compare to Dr Berger would be much appreciated. I have heard good things about all of them but I am not sure how to research their skill levels. I am also willing to look into other options if needed and I would travel for surgury if needed.

Dr. Green is a DO, which means he did not go through quite as much medical training as an MD. But the plus about DOs is that they tend to treat the whole body and not only the joint being replaced. He had training in reconstructive surgery which is a plus.

Dr. Schnaubelt is probably not a good option. He specializes in sports medicine and a number of joints which likely means he doesn’t do as many hips as someone who just does hips and knees.

Why don’t you meet with Dr. Green and Dr. Berger, talk about your hip and the idea of having to travel with Dr. Berger and see what seems most comfortable.

 

[Bangeduphip]

Thank you so much, I will start with Dr. Green and Dr Berger. And probably lean towards Dr Green if my insurance verifies that Dr Berger is out of network. To be thorough, I will check if I can find other options for comparison. Thanks again.

 

[AlanInAZ]

You can find the number of hip replacements for each surgeon on the Medicare website that were billed against classical Medicare. Surgeries paid by Medicare Advantage and private insurance are not included so the number is incomplete but it gives an idea of the relative number for the surgeons. I looked up both Dr Schnaubelt and Dr Green. Dr. Schnaubelt performed 41 hip replacements and Dr Green performed 29 hip replacements in 2021 billed against classical Medicare. The data can be found on data.cms.gov. I always look up my doctors to get a feel for the scope of their practice. Dr. Richard Berger is not listed in the Medicare database.

According to US News and Health Report Dr. Schnaubelt is in the 92nd percentile for number of hip replacements performed in his region. He is in the 83rd percentile for hip and knee revisions. I would certainly give him a look if I lived in your region.

 

[Freyagirl]

Consider looking at infection stats for the surgical center as well. Be aware that even if you are going in for same day surgery some issues like blood pressure, nausea, and blood loss can keep you overnight in the hospital.