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The Surgery
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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.
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 HR 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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