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Surgeon Choice
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How many surgeries to get up the learning curve?
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Dr.
Amstutz: This very much depends on the
previous experience level of the surgeon, the amount of time spent with an experienced
resurfacing surgeon and the rate at which the surgeon is doing them ie one per
month is probably not enough to develop great technique. Most failures from fractures
or complications occur in the first 10.
Dr. Mont: Experience levels for resurfacing surgeons vary. There are some surgeons
that can be experts after doing a few cases. They are very used to learning new
procedures, evaluating them in minute detail and they can score a homerun very
quickly. There are other surgeons that need to perform scores or more of these
procedures before they can become proficient. There are some studies that say
that surgeons need to have performed a minimum of 50 or more cases to be proficient
and there are other studies and this surgeon in particular that feel that many
talented surgeons do not have to do this many to be proficient in resurfacing.
This type of decision has to be on an individual basis as well.
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How do you judge whether a new HR surgeon
is competent? Especially one that doesn't have a big loyal following?
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Dr.
Schmalzried: There are a handful of internationally
recognized experts with outcomes data that they can show. The number of competent,
experienced resurfacing surgeons in the U.S. is growing.
Simply knowing the number of resurfacing cases the surgeon has performed may
not be the best way to evaluate their skill. There is a learning curve, but it
is not the same for all surgeons - so one should always be cautious. Doing more
does not always mean doing better.
Some other surrogates include their experience with total hip replacement and
their outcomes with that procedure. Ask to speak with some patients who they
have operated on - even if it was a total hip.
Ask the surgeon, point blank, if there is someone more competent than they are
to do hip resurfacing. Are they willing to put that statement in writing?
Dr. Amstutz: Find out how he learned resurfacing. Did he take a class, observe,
scrub in and assist? Did he spend time with an experienced resurfacing surgeon?
Has he done 50?
Dr. Mont: Competency on a resurfacing surgeon is hard to evaluate from a patient
perspective. Patients cannot sit there and look at the x-rays and see how well
they are performed. Some of what they have to accept is the word of a surgeon
concerning how competent they feel and how comfortable they are with that surgeon.
Sometimes it might behoove the patient to interview patients that have had resurfacings
by that surgeon. It’s typically not problematic for a surgeon with permission
from the patients to provide a list of names of successful patients and I think
this might be one of the only ways from a patient perspective to evaluate a surgeon.
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On a surgeons stats--how can you find out
how many assists they performed as well as sole surgeon?
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Dr.
Schmalzried: There
are a handful of internationally recognized experts with outcomes data that they
can show. The number of competent, experienced resurfacing surgeons in the U.S.
is growing.
Simply knowing the number of resurfacing cases the surgeon has performed may
not be the best way to evaluate their skill. There is a learning curve, but it
is not the same for all surgeons - so one should always be cautious. Doing more
does not always mean doing better.
Some other surrogates include their experience with total hip replacement and
their outcomes with that procedure. Ask to speak with some patients who they
have operated on - even if it was a total hip.
Ask the surgeon, point blank, if there is someone more competent than they are
to do hip resurfacing. Are they willing to put that statement in writing?
Dr. Amstutz: Ask them directly. Find out how many assists they have performed
and how many they have performed as the sole surgeon. How many they have done
in the past year would also be instructive since volume develops technique.
Dr. Mont: It is very difficult to find out how many assists or how many procedures
that any specific surgeon might have performed. Sometimes data is published in
the form of reports, but other than that, the number of cases that a specific
surgeon has performed is simply anecdotal and not obtainable.
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What experience level should I search for
in a Hip Resurfacing Surgeon?
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Dr.
Schmalzried: There are a handful of internationally
recognized experts with outcomes data that they can show. The number of competent,
experienced resurfacing surgeons in the U.S. is growing.
Simply knowing the number of resurfacing cases the surgeon has performed may
not be the best way to evaluate their skill. There is a learning curve, but it
is not the same for all surgeons - so one should always be cautious. Doing more
does not always mean doing better.
Some other surrogates include their experience with total hip replacement and
their outcomes with that procedure. Ask to speak with some patients who they
have operated on - even if it was a total hip.
Ask the surgeon, point blank, if there is someone more competent than they are
to do hip resurfacing. Are they willing to put that statement in writing?
Dr. Amstutz: There is a substantial learning curve for hip resurfacing. You would
want a surgeon who was quite experienced with THR and has had good results with
resurfacing. Excellent technique can only be developed by doing the surgery regularly.
Of course, you can always ask to speak with post-op patients. The more experience
a surgeon has, the better.
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