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A Closer Look: Hip-Replacement Surgery

If “have hip replaced” is at the top of your to-do list, you’re not alone. There are millions of Americans living with artificial joints: 2.5 million with new hips and 4.7 million with new knees, according to the American Academy of Orthopaedic Surgeons. And though Medicare is the primary payer for the majority of these replaced joints—which means most of the patients are 65 years old and older—the trend is skewing younger.

Hip mechanics: The hip joint is essentially a ball-and-socket structure. In a healthy hip, smooth cartilage covers the ends of the thigh bone and pelvis, allowing the ball to swivel easily within the socket. In a damaged hip, the cartilage is worn away and no longer serves as a cushion between the ball and socket. When these worn areas rub together, movement is painful.

Total-hip-replacement surgery removes the worn, rough parts and replaces them with smooth parts. The femoral head, or ball, of the hip is replaced with a prosthetic ball and stem, and the acetabulum, or socket, is lined with an artificial cup. The result is a new ball designed to move easily within a newly lined socket.

Choosing your team: If you need hip-replacement surgery, one of the most important decisions you’ll make is selecting an experienced orthopedic surgeon. Look for someone who does 30 or more hip-replacement surgeries a year and has at least 100 under his or her belt.

“Choosing a qualified orthopedic surgeon is fundamental to minimizing the risk of complications and poor outcomes,” says John Clohisy, MD, a Washington University orthopedic surgeon and co-director of the adult reconstructive surgery service at Barnes-Jewish Hospital. “In general, surgeons who dedicate a significant portion of their practice to joint-replacement surgery, specifically hip replacement, are most suitable to provide high-quality care.”

And you should choose a good hospital, Clohisy says. Medicare recently released a list of the best and worst hospitals for hip- and knee-replacement surgery, identifying 97 hospitals where patients were most likely to have smooth recoveries. In the St. Louis area, Barnes-Jewish Hospital was the only hospital where patients fared better than the national average.

You can also decide to be as healthy as possible before surgery—loose weight if needed, keep muscles flexible and toned. And you can determine ahead of time that you will adhere to the physical-therapy regimen your doctor prescribes for you once you’re discharged from the hospital.

The path to successRosemary Schriefer had her hip replaced in 2011. She went from walking with a cane to working out on an elliptical machine and taking Zumba classes. It took Schriefer seven months to get from point A to point B, but, she says, “I didn’t give up on myself.”

Clohisy says, “Rosemary’s commitment to fitness indicated that she would be a good candidate for a successful hip replacement.”

Read more articles from Innovate Fall 2014.

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