Check Out Who Will Do Your Hip Surgery
Technique matters more than the prosthesis, experts say

(HealthDay News) -- Anyone thinking of having hip-replacement surgery to ease their pain might be wise to spend more time researching which surgeon should do the procedure than which implant would be best.

Surgical errors are to blame for most failures, according to a large survey.

Dr. Kevin Bozic, an associate professor of orthopedic surgery and health policy at the University of California, San Francisco, said the findings are important because hip replacement has become very common in the United States. Bozic was lead author of a report on the survey and is on the board of the American Academy of Orthopaedic Surgeons.

"Together with knee-replacement surgery, it's one of the three most common operations," Bozic told HealthDay. "And the frequency is increasing dramatically because of a number of factors, including an aging population, people having it done at a younger age, and new and improved technology and techniques," he added.

"This study is the first to give us information from a very big national database on the cause of failure in a large population," Bozic said. "What it does suggest is that when hip replacement does fail, the weak link is not the wearing out of the bearing surface, but other problems that in large part are probably related more to the surgical technique used rather than the implant device itself."

The study, which one expert called "fantastic," found that the most common cause for hip-replacement failure was dislocation of the implant. Next on the list were loosening of the implant, followed by infections.

To reach their conclusions, the researchers analyzed a nationwide hospital survey conducted from October 2005 to December 2006. The survey included data on all hip-replacement surgery revisions that were performed after initial hip-surgery failure -- more than 51,000 surgeries.

Because the data were the first collected under a more detailed diagnostic and procedural coding system for hip replacements, Bozic and his colleagues were better equipped than previous researchers to identify failure trends.

"So the message is simple," he said. "We found that there are causes of hip-replacement failure that we hadn't believed were the most common causes but that we now know are significant concerns and should be investigated further."

Dr. Jay Mabrey, chief of orthopedic surgery at Baylor University Medical Center in Dallas, was very enthusiastic about the survey findings.

"This is a fantastic study," Mabrey told HealthDay. "It's about time that someone went about proving that technique is more important than the prosthesis itself."

The bottom line, Mabrey said, is that "as a consumer you really should be concerned more with the surgeon who is going to put in the replacement and less concerned with which implant is being put in."

On the Web

To learn more about hip replacements, visit the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Hip_Replacement/default.asp

SOURCES: HealthDay News; Kevin Bozic, M.D., M.B.A., associate professor, orthopedic surgery and health policy, University of California, San Francisco; Jay Mabrey, M.D., chief, orthopedic surgery, Baylor University Medical Center, Dallas; January 2009, Journal of Bone and Joint Surgery; American Academy of Orthopaedic Surgeons (www.aaos.org)
Author: Dennis Thompson Publication Date: Jan. 31, 2010
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