Patient advocate: Tips for hip, knee replacement surgery
A few weeks ago, I underwent my second total hip replacement. I had already replaced my left hip, and now it was time for the right one.
About 10 years ago, I also had both of my knees replaced. After nearly four decades as an ICU nurse, the physical toll of caring for patients, some weighing up to 300 or 400 pounds, had caught up with me. This is a common story among nurses: We prioritize others' needs and often ignore our own warning signs.
Obviously, I’m not alone. Around 7 million Americans are living with hip or knee replacements, allowing them to maintain mobility despite severe arthritis. Annually in the U.S., there are about 700,000 knee and 400,000 hip replacements, with studies showing many replacements lasting 25 years or more.
We’re just not as healthy as we used to be. Arthritis inflammation in the joints can actually destroy the cartilage, and when you hit bone-on-bone, it causes not only significant pain but also disability. The increase in hip replacements is attributed to the aging baby boomer population, rising life expectancies and the obesity epidemic. Sports injuries and accidents are additional factors.
I’ve learned a lot about joint replacement — as a nurse, a patient advocate and a patient. If you’re facing a joint replacement, here are some considerations:
Hospital or surgery center?
All four of my joint replacements took place at outpatient surgery centers, which I consider much cleaner environments than hospitals. After early morning surgery, I was home by noon and received home health care, so I never went to rehab.
A 2023 study by University of Pennsylvania researchers found that the rates of revisits and complications for surgery center patients were lower than for similar patients who had surgery in a hospital. However, that could have something to do with healthier patients choosing surgery centers and those with other health conditions, heart failure for example, going to hospitals.
That said, this is a topic for you and your doctor to discuss. In the end, you will decide where to have your joint replacement, so go where you are most comfortable.
Choosing a doctor
Look for a surgeon who is affiliated with professional organizations and has completed fellowships in the surgery you’re having. You should also prioritize their experience, asking how many times they’ve performed this particular surgery.
Studies have found that surgeons who have performed more than 50 procedures have lower rates of complication and revision. You can ask the doctor directly how many times they’ve performed the surgery and what their complication rate is. Also ask whether you can speak with other patients the doctor has treated.
Second opinions
Joint replacement is a major medical undertaking, so if you’re feeling at all unsure about it — or the doctor isn’t all you had hoped — Medicare covers second opinions subject to the 20% co-insurance. Medicare Advantage plans also generally cover second opinions, but check with your plan for details.
Robots or no robots?
Robot-assisted joint replacement is becoming more common. A study published in the Journal of Arthroplasty reported an increase in surgeons who have adopted robotics, from 10% in 2018 to 35% in 2023. Nearly half of partial knee replacements were robotically assisted. Fewer total knee and hip replacements were reported.
The study noted that further research is needed on outcomes, but surgeons who use robotic assisted systems say that the robot is simply the navigation system while the doctor is in the driver’s seat.
Rehab in a facility or at home?
With my surgeries, I wanted to avoid a rehab facility because that’s another name for nursing home, where there are a lot of germs, more patients with compromised immune systems and generally higher infection rates.
Today, in fact, most joint replacement patients do recuperate at home. A project by the Centers for Medicare and Medicaid Services found that patients who can safely recover at home heal faster, have fewer complications and have a greater sense of ownership in their own recovery.
Not everyone can come home immediately, though, if they lack family support or access to home health care. Be sure to have this conversation with your doctor before your surgery.
Chances are your joint replacement will get you back to doing the things you enjoy, especially with a little bit of education and preparation.
• Teri (Dreher) Frykenberg, R.N., a registered nurse and board-certified patient advocate, is the founder of www.NurseAdvocateEntrepreneur.com, which trains medical professionals to become successful private patient advocates. She is the author of “How to Be a Healthcare Advocate for Yourself & Your Loved Ones” and her new book, “Advocating Well: Strategies for Finding Strength and Understanding in Health Care,” available at Amazon.com. Contact her at Teri@NurseAdvocateEntrepreneur.com to set up a free phone consultation.