Best Practice Health TV
Total hip replacement is a life changing treatment for people with disabling hip pain due to severe arthritis that has lasted longer than 12 weeks despite conservative care.
· Minimally invasive approach
· Well trained and experienced orthopedic surgeon
· Robotic assistance
· Outpatient or highly rated hospital facility
· Proven implants
· Efficient office
Minimally invasive approach – a minimally invasive approach is critical to reduce the pain of surgery, speed recovery, lower the risk of complications, and make sure there are no permanent restrictions. You have three minimally invasive approaches to choose from: anterior, direct superior, and superPATH. Be wary of surgeons who use the legacy ‘posterior’ approach as it weakens the hip joint, hurts, and leaves you with permanent restrictions.
Well-trained and experienced surgeon – we recommend an orthopedic surgeon who is fellowship-trained in joint replacement surgery and does at least 100 joint replacements per year. The best surgeons pick one approach and stick with it.
Robotic assistance – the Stryker Mako is the first robotic to be widely used, but all of the major implant manufacturers are relying on the future of robotics and introducing a system of their own. Robotic assistance enables orthopedic surgeons to be tremendously more accurate in their work. But the biggest benefit to robotic assistance is in the selection and placement of implants. Studies show surgeons place hip implants more accurately, with a 400% reduction in the risk of postoperative dislocation, when they use a robotic assistant. Do not have hip replacement surgery without it.
Outpatient or highly rated facility – to reduce the risk of hospital errors and infection, we recommend having your hip replaced in an ambulatory surgery center. If there is no ambulatory surgery center in your city, then a highly rated hospital is preferred. The government website Hospital Compare publishes the rate of complications for total joint replacement by hospital for Medicare patients. Do not have surgery in a hospital with above average rate of complications.
Proven implants – registries of consecutive patients who have joint replacement surgeries have shown some ball and socket combinations have much better track records than others. In the Australian registry, cementless implants are used more frequently than those that require cement. The Trident (Stryker), Pinnacle (DuPuy), and trinity (Corin) were the most popular sockets, while the Corail (DuPuy), Accolade II (Stryker), and Metafix (Corin) were the top three balls.
Efficient office–patient satisfaction reviews on the internet are a good indication of the efficiency of an orthopedic surgeon’s office. We recommend looking at the average and exclude rankings without enough reviews to create a reliable rating.
Wesley Richards is an avid pickleball player, but a few years ago, his hip pain was getting in the way of his game. Wesley knew a lot about hip pain: he had his first hip replacement nine years earlier. After a misdiagnosis, multiple consultations, and some hesitation on his part, Wesley eventually found the care [...]
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Great question. The anterior approach that your sister had is what people call a “minimally invasive approach.” The other two minimally invasive approaches to total hip replacement are superPATH and Direct Superior. In this response I am going to use the term “minimally invasive approach” to mean any one of those three. Thankfully, whether the [...]
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Have you ever noticed how when celebrities or heads of state have total hip replacement the surgeon always seems to use a robotic assistant? You saw it a couple of weeks ago in the footage of Kris Jenner’s surgery. There is a reason for that. Rich people don’t like to suffer. You probably don’t, either; [...]
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Last week we talked about Kris Jenner’s hip replacement surgery which she courageously broadcast on HULU. When Kris Jenner wanted to know if her hip pain was bad enough for hip replacement surgery, she did what most people do...she invited a friend over to talk about it. The friend was Martha Stewart. Everyone has that [...]
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You should do 3 weeks of physical therapy before considering an MRI—studies show worse results if you get imaging at this point. If you are not better after 3 weeks of therapy, then (6 weeks since the pan began) you should get an MRI and referral to a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management. They will do a medial branch block and radiofrequency ablation as appropriate. Don’t let anyone talk you into epidural injection; that is not what you need.
You should do 3 weeks of physical therapy before considering an MRI—studies show worse results if you get imaging at this point. If you are not better after 3 weeks of therapy, then (6 weeks since the pan began) you should get an MRI. We can help you find a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management who doesn’t over-prescribe dangerous narcotics.
They will offer you medial branch block and epidural injection. Those don’t really work for this problem. Your options are (off label) intradiscal injection of stem cell-derived growth factors, denervation with the relevant procedure, and then referral to a spine surgeon for interbody fusion if those fail.
You need an MRI now and referral to a spine surgeon for possible laminectomy decompression surgery. We can help you find one who is board-certified and specializes in minimally invasive surgery.
You need an MRI now and referral to a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management. Don’t go to one that prescribes a lot of narcotics, they may get you killed. If you’re not better after 3 epidural injection you will be referred at 12 weeks to a spine surgeon to consider microdiscectomy. Note that you DO NOT need radiofrequency ablation; so, don’t let anyone talk you into a medial branch block.
This stuff can be confusing. Don’t sweat it. We’ve got you. Your MRI came with a report by a radiologist which describes the findings. If you don’t have a copy of your report, you can get one from the imaging center where the x-ray was taken. The doctor who prescribed the MRI has a copy as well. Find the section labeled Impression. First, under the impression, look for the word normal. If you see something like “Normal MRI of the hip then you are done. You do not need to check anything.
Next, search the impression section for the words osteonecrosis or avascular necrosis. If you see either one in the report, then ignore the rest of the report and check the osteonecrosis box. If neither of those is in the report, ignore the rest for now and continue.
This stuff can be confusing. Don’t sweat it. We’ve got you. Your x-ray came with a report by a radiologist which describes the findings. If you don’t have a copy of your report, you can get one from the imaging center where the x-ray was taken. The doctor who prescribed the x-ray has a copy as well. Find the section labeled Impression.
First, under the impression, look for the word normal. If you see something like “Normal x-ray of the hip then you are done. Check the box normal. Next, search the impression section for the word hypoplasia. If you see hypoplasia in the report then ignore the rest, and check the hypoplasia box.
If you are still going, then look for the word arthritis. The radiologist should have given the arthritis a grade from 1 to 4. If you see arthritis in the impression section but there is no grade, then look at the rest of the report for a grade 1,2,3 or 4 and check the appropriate box. If there’s no grade then you have every right to call the imaging center and ask them to have the radiologist to do their job and redo the report with a grade.
Not all orthopedic surgeons are the same. You deserve the best. That means a surgeon who is
In my experience less than 10% of orthopedic surgeons meet all five of these criteria. That means if you go to the surgeon you’ve been seeing, or the one recommended by friends or family, there’s a 90% chance you will not be getting the best.
At Phoenix Spine and Joint we make it our business to know the best. Call us for help finding the best surgeon near you who takes your insurance and is accepting new patients.
If you have any of the following red flags you need to see a doctor NOW!
Radiculopathy. This condition is most often due to herniated disc, but can also be caused by bone spurs, or compression of nerve roots as they leave the spinal canal. The traditional treatment is to confirm the herniation or compression by MRI, followed by a trial of epidural injection, with microdiscectomy or laminectomy surgery if all else fails.
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Facet syndrome. Your low back pain is most consistent with arthritis. Look for confirmation on your x-ray and MRI reports with discussion about “arthritis.” The traditional treatment is radiofrequency ablation done by a pain management physician.
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Discogenic low back pain due to an annular tear. Sorry, this is the least common and the hardest to treat. Traditionally, the recommended procedure is fusion; however, that does not always work and causes adjacent level issues. More recently a denervation procedure was approved called the Intercept procedure from Relievant. Some doctors recommend injection, The two options are stem cell-derived growth factors, and ozone.
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