Deciding on surgery??

[donnab]

I am trying to educate myself on surgery, preparation, etc and welcome input.

I visited the orthopedic surgeon who took two x-rays and told me i needed a total hip replacement.

My friend went to an orthopedic surgeon in another town who insisted on blood work and physical manipulation before making a determination. He discovered she had arthriitis and also advised her to see a rheumetologist.

The surgeon I saw asked if anyone had ever told me i had arthritis...i said no and he said that he was telling me i did.

He did ask for blood work from my primary care physician a few weeks before the surgery.

What have been your experiences about this? What was the process of deciding on surgery?

Also, I'd like to get a second opinion and my insurance tells me to get the x-rays from the first doc. I am a bit nervous about irritating him (I know it should not be that way but I still feel that it might)...ideas on this and second opinions.

Thanks so much. Donna

 

[wizzard]

without question you should get a second opinion (if only to give you peace of mind)i saw 4 doctors since 2001 before finally having it done 11/26/2007.you will know when it is time.i am glad i waited because the products are better in just 6 years time .i refused to believe i really needed it for years.

 

[donnab]

Thanks so much for your thoughts. It is a big decision.

Whlle I can do fairly welll on pain management, though there are really bad days, my biggest loss is that it confines my lifestyle and I miss my long walks and traveling....can do very little at this point.

Thanks again.

 

[Josephine]

Donna, are you feeling shortchanged because you didn't seem to get the same as your friend? Don't worry about it. It's my impression that your surgeon knows what he's talking about! To be perfectly frank, you only need the xrays to see if a person needs a THR. The blood work needn't be done till you are in hospital. And a visit to a rheumatologist? Why bother? They are not going to change anything.

But I would certainly get a second opinion - and a third for that matter. Some people even get a fourth! The important thing is that you choose a surgeon who listens to you, who seems to be genuinely interested in your point of view and inspires your confidence.

You also need to find out or ask three things .....
1. how many of these operations has he done in the last 1 or 2 years. Anything over 500 per year would be good.
2. what is his infection rate and don't let him fob you off with a 'zero' - there's no such thing! However, anything under 1.5% would be good.
3. what is his percentage of long-term acceptable outcomes; unacceptable outcomes include dislocations, loosenings, breakages and undefined long term post-op pain.

 

[wizzard]

i was in the exact situation.could i have waited? yes but my quality of life was way off.everything was extra effort.and i have 2 children ages 1 and 3.i could have been fine if i wanted to live a somewhat inactive lifestyle but what is the cost of that?weight gain high blood pressure overall compromise of total health.i would walk a mile and could swear it was 5.i was running marathons in 2001.and as far as the reports from styker.my os told me in june on my fist visit to him that he had repeatedly gone to them about the failure rate of the product.even suggested a solution.they did not want to listen.he has since switched to smith and nephew.but who knows .

 

[donnab]

Thank you so much for your feedback. It is solid. Thanks for the tips on what to learn about the surgeon. I am very, very grateful.

 

[pt109]

A doctor who is not in favor of a patient getting a second opinion is a doctor I would not want operating on me. I had both hips replaced recently, by the same surgeon, and I got a second opinion each time - just for my peace of mind.

You will feel a million times better once you are on the healing side of the surgery and you will wonder why you waited so long. The first few weeks are tough, but after that things get better rapidly.

 

[Josephine]

Couldn't agree more, pt!

 

[Stanj]

Hi Josephine
I am a little surprised that the criteria for a surgeon would be 500 a year, do surgeons really crank out that many or more? I would be concerned if I was one of several he had scheduled for the same day bcause the studies I've read suggests that the number of people passing through an operating theater each day has a strong relationship to infection rates. Taking out days for rest and vacations, holidays, other types of operations plus consultations, that must mean "operating days" would see be 2-4 hip replacements. That just seems like a lot. I know in the US, just under a majority of births are by Ceasarian Section now because doctors can schedule quite a few in a day rather than letting nature run its course. When my then wife became pragnant we looked for a a doctor who did not insist on that operation and it took a long time to find one who would only do one as the last resort instead of standard practice for time management reasons. I would also prefer a surgeon who was not under such a heavy schedule and pressure to do so many. What is the best balance between experience and flexible schedule? The surgeon I am using is generally regarded as the most experienced in the city of 5+million people but he only does 100 a year. Everyone I talked to, friends who were doctors or medical professionals, kept mentioning his name as the one to seek out. Is performing less than 500 really a warning indicator? There is a different philosophy here obviously, where the doctor/patient/nurse ratio is a lot closer to 1:1:1 than where I am from. US hosptials are not great for infection rates according to a number of studies and the high turn-over of operations per day might be a factor.
Stan

 

[pebitpeb]

Good input from everyone in regards to making a decision. I would have to add what quality of life you are having now, what level of pain and discomfort is happening, is your rest affected and are you taking pain medications. The second opinion is needed, I had 4 since the artheritis set in and in the US was offered possibilities of seeing a specialist and being able to come up with large amounts of cost toward the visits, as the insurance I carried was not great. I have gone from noticing tingling in my hips to walking with a cane and for long distance(airports, walks, shopping)using a wheelchair, I take a cocktail of pain and anti inflamatory meds every day that I also must take a stomach protector from. I am young enough that I can not settle for a limited mobility in my life. I appreciate the facts and concerns posted here as all are relivant and should be considered. Make the decision for yourself and your needs and remember that no guarantees come with this surgeries, there are statistics and forcasts that can be given. In whatever you decide, I wish you the best.
pebitpeb
Paul

 

[Josephine]

Stan, I was asked the almost identical question over on the knee forum. But my answer is the same and I will try to define it for you.

The average THR takes about 1-1½ hrs. An operating session here in the UK is nominally 4-4½ hrs thus about 2-3 THRs can be done. Plus they often do all day sessions and can even get in an extra case, thus making 5-6 hips possible. Each surgeon does about 4-6 sessions per week or 2 all days with extra at the weekend therefore 5 hips x 2 days = 10 per week with maybe another 5 at the weekend. This can be a total of 15 per week.

Now given that each year, a doctor has 6 weeks annual leave and 4 weeks study leave, that leaves 42 weeks to work. 15 x 42 = 630 per year which, granted, is a VERY rough calculation but 500 per year would be a minimum for most active hip surgeons. Personally, I would not even want to book a consultation with a surgeon who does less.

Let me put it this way - you want an extension on your house. Are you going to engage a builder who only works 2 days a week? Or you want to get a financial advisor to invest your hard earned savings. You going to hire a chap who has only limited experience on the stock market? No - you will look for a person who has considerable experience, whose opinion is backed not only inside knowledge but by a wealth of personal hands on experience.

IMO 100 hips a year is just a hobby!

 

[Vjklander]

My doc was the second opinion. Once the x-ray went up on the viewer it was obvious. I was 3 weeks post-op yesterday. There is a whole list of recommendations I would make if you are interested.

 

[Josephine]

Vj - that post is almost 3 months old!

I'm closing this so it doesn't get bumped again.