September 10, 2008 > Success of Hip Replacement Depends on Surgeon's Skills
Success of Hip Replacement Depends on Surgeon's Skills
Recent reports in the media, including an article in The New York Times, have raised concerns about the safety of a particular hip replacement implant, known as the Durom cup. The media attention also has increased the support among physicians for a national database that tracks how well patients with joint replacements fare.
"Dr. Lawrence Dorr, a prominent orthopedic surgeon in Southern California, reported problems with the Durom cup to the device's manufacturer after he was not getting the results he expected," says Dr. John Dearborn, Medical Director of the Center for Joint Replacement at Washington Hospital.
"We have never used this particular implant, but not because of Dr. Dorr's concerns," Dr. Dearborn notes. "The Durom cup has metal-on-metal bearings, which I believe do not work as well as the mainstream implants used today. We use implants that have a proven track record. These devices have extremely durable, low friction-bearing surfaces so they don't wear out. Patients can generally expect a hip replacement to last a lifetime."
While he has never used the Durom cup, Dr. Dearborn agrees that a national database to track results of joint replacement surgeries is a good idea.
"Tracking joint replacement data can improve future outcomes, and we've been trying to start a national database for a long time," he says. "Several countries already have this type of database, but none of them has a population as large as the United States. For example, Canada, with its system of nationalized medicine, has a database, but they restrict this type of surgery to large regional centers, so the data is easy to compile. We would need to approach it in a different way, but we do need a better reporting system."
There also are problems in creating a database that includes surgeons who do joint replacements only occasionally, according to Dr. Dearborn.
"Surgeons who perform only a few joint replacements a year are not going to have as good a result as those who perform hundreds of such surgeries a year - regardless of which implant they use," he explains. "Implants are generally safe, especially when the procedure is performed by a surgeon with extensive experience. That's why I would recommend creating a database that tracks the results of physicians who are doing several hundred of these surgeries a year - it would be more realistic and useful."
The Center for Joint Replacement has tracked the results of joint replacement surgeries performed there for the past 11 years.
"We know what our results have been for the more than 6,000 hip and knee replacements we have performed," Dr. Dearborn says. "Our track record at Washington Hospital is excellent. We have had only one incident in over 3,000 first-time hip replacements where the socket failed, and that was because the patient's own bone failed, not because of a faulty implant or surgical technique."
Dr. Dearborn cautions that anyone who is contemplating joint replacement surgery should be careful in selecting a physician to perform the procedure. "Ask prospective surgeons how many of these procedures they have performed, what implant device they recommend and what their track record is with that particular implant," he suggests. "You should also ask for testimonials from other patients whom they have treated."
Patients at the Center for Joint Replacement have access to the center's "Voices of Experience" database that provides the names of former patients who are willing to discuss their experience with prospective patients.
For more information about minimally invasive hip replacement, visit www.whhs.com/services/joint or call the Center for Joint Replacement at (888) 494-7003.
To help people learn more about the latest advances in minimally invasive hip replacement, Dr. Dearborn will be conducting a special Health & Wellness seminar on Tuesday, September 16, from 1 to 2:30 p.m. The seminar will be held in the Conrad E. Anderson, M.D. Auditorium located at 2500 Mowry Avenue in Fremont. For more information about the seminar, or to register to attend, please call (800) 963-7070.