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GETTING A NEW JOINT? DO IT RIGHT THE FIRST TIME

Joint replacements sometimes need to be redone. An experienced surgeon and the right implant improve your odds.

New York Times

There is nothing like a new hip or knee to put the spring back in your step.

In 2007, U.S. surgeons performed about 806,000 hip and knee implants (the joints most commonly replaced), double the number performed a decade earlier. Though these procedures have become routine, they are not fail-safe.

Implants must sometimes be replaced, said Dr. Henrik Malchau, an orthopedic surgeon at Massachusetts General Hospital in Boston. A study published in 2007 found that 7 percent of hips implanted in Medicare patients had to be replaced within 7-1/2 years.

The failure rate should be lower, many experts agree. Sweden, for instance, has a failure rate estimated to be a third of that in the United States.

Sweden also has a national joint replacement registry, a database of information from which surgeons can learn how and why certain procedures go awry. A registry also helps surgeons learn quickly whether a specific type of implant is particularly problematic. "Every country that has developed a registry has been able to reduce failure rates significantly," said Dr. Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn.

A newly formed American Joint Replacement Registry will begin gathering data from hospitals in the next 12 to 18 months.

If you are considering replacing a deteriorating knee or hip, here are some ways to raise the chances of success and avoid a second operation.

1 Choose - or request a referral to - an experienced surgeon at a busy hospital.

"The most important variable is the technical job done by the surgeon," said Dr. Donald C. Fithian, an orthopedic surgeon and the former director of Kaiser Permanente's joint replacement registry.

Ask for recommendations from friends who have had successful implants and from doctors you know and trust. When you meet with the surgeon, ask how many replacements he or she does each year.

A study published in The Journal of Bone and Joint Surgery in 2004 found that patients receiving knee replacements from doctors who performed more than 50 of the procedures a year had fewer complications than patients whose surgeons did 12 procedures or fewer a year.

2 Understand that not everyone with joint pain will benefit from a joint replacement.

An implant can help reduce pain and improve mobility if the joint surface is damaged by arthritis, for instance. But a new joint will not help pain caused by inflammation of the surrounding soft tissue, said Berry, who is also vice president of the board of the American Academy of Orthopaedic Surgeons.

Some people with mildly arthritic joints, for instance, can manage well with the judicious use of medication. If you have uncontrolled high blood pressure or another serious chronic condition, a joint operation may simply be too risky for you.

3 Pick the right joint. In general, be wary of the latest, most advanced new joint.

There is little evidence to support the use of more expensive designs over basic ones, said Dr. Tony Rankin, a clinical professor of orthopedic surgery at Howard University. One recent study found that premium implants fared about as well as standard implants over a seven- to eight-year period.

4 Once you have a recommendation or two from a surgeon, find out how well the joint has performed in others and if there are known complications.

The newer metal-on-metal hip implants, for instance, are somewhat controversial and may cause tissue and bone damage in certain patients. Ask if the hospital has a registry that tracks joint replacements. If so, ask to see the data on the implants you are considering.

You can learn more about your operation at this American Academy of Orthopaedic Surgeons website: orthoinfo.org.

5 Recovery takes a different course for each patient, depending on the type of procedure and implant.

In general, expect mild to moderate pain for the first few weeks. Some patients are able to return to work in one to two weeks, but full recovery can take six to 12 months, said Dr. Joshua J. Jacobs, chairman of orthopedic surgery at Rush University Medical Center in Chicago.

Make sure you have the help you need in the initial stages of recuperation. You may want to have a friend or family member stay with you or hire an aide or visiting nurse.

Follow your doctor's orders, and don't rush your recovery. You don't want your new joint to fail because you couldn't resist carrying loads of laundry up and down stairs.

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