The Secret Question To Ask Your Orthopedic Surgeon

Your orthopedic surgeon says, after perhaps months or years of treating your hip or knee pain, that conservative treatment is no longer working. The pain and your level of mobility are affecting the quality of your daily life and that it’s time to consider joint replacement surgery. Conversations like this between orthopedic surgeons and patients are a common occurrence across America.

If there is one important question you can ask of your orthopedic surgeon to ensure a better outcome before you undergo knee or hip replacement surgery, it is: “How many joint replacement surgeries do you do each year.” According to a national study conducted by Clarify Health Institute – which reviewed more than 180,000 hip and knee replacement surgeries – orthopedic surgeons who perform the highest number of surgeries had the fewest number of infections, readmissions and experienced overall better patient outcomes.

The study looked at surgical volume data from 2017-2020 and although surgical volume varied among doctors, about one third of hip and knee replacements were performed by surgeons with 100 or more prior surgeries, while 50 percent were performed by surgeons who had completed less than 50 surgeries. Higher surgical volume was associated with better outcomes for both hip and knee replacements. Rates of post-hospital readmission at seven and 60 days were between 37 percent and 51 percent lower for surgeries with high-volume doctors compared to those with low-volume doctors.

High-volume doctors were also associated with lower rates of revision surgeries and post-surgical stay orthopedic visits. Cost was also a factor. Total hip and knee surgery costs were $2,800 and $1,500 lower, respectively, when high-volume surgeons performed the procedures over low-volume surgeons.

The surgical setting also made a difference to higher-volume surgeons. Post-surgical emergency visits were 21 percent lower in an inpatient setting, 35 percent lower in an outpatient setting and 34 percent lower in an ambulatory surgical (ASC) setting.

There have been other studies that concluded similar outcomes for higher-volume surgeons performing hip and knee replacement surgeries, but this study was one of the largest.

Patients may not ask or be aware of the profound differences between seeing an orthopedic surgeon who does a lot of hip and knee replacement surgeries and one who does only a handful each year. There is a call for more transparency among health care providers to publish and share surgical volume information with their patients.

At Hoag Orthopedic Institute, for example, the largest volume provider of hip and knee replacement surgeries in California, we publish a yearly outcomes report (available online) that shares our volumes as well as other key information about surgical outcomes. I sincerely wish other health care institutions would share in our belief to be transparent in surgical performance.

Until more hospitals and health care providers do that, ask your surgeon questions about their surgical volume to be as informed as possible. It can make a world of difference.

Jay Patel, M.D. is an orthopedic surgeon who specializes in hip and knee replacements and is Chief of Strategy for Hoag Orthopedic Institute in Irvine, California.