Top Docs: Understanding hip replacements

Many people with limited hip function or chronic hip pain are able to resume reasonably active lives after having their hobbled hips replaced with man-made parts.

Roughly 230,000 total hip replacements are done each year in the United States, according to the U.S. National Center for Health Statistics.

The procedure involves removing damaged bone and cartilage and inserting an artificial joint.

REASONS

Hip replacement is major surgery and is not recommended for people whose arthritic pain can be managed with medication.

"If they have an abnormality of their hip and/or arthritis, and it's causing enough functional limitations and pain, those are the people who are the candidates for it," said Dr. Stanley Asnis, chairman emeritus of orthopedic surgery at North Shore University Hospital in Manhasset and Long Island Jewish Medical Center in New Hyde Park, who will be a clinical professor of orthopedics at Hofstra University School of Medicine in Hempstead when it opens in 2011.

The typical candidate is someone with a condition such as:

• Osteoarthritis, caused by wear and tear of the cartilage that cushions the hip joint.

• Rheumatoid arthritis, a chronic condition that causes joint pain, swelling and stiffness.

• Hip fracture, the result of a fall or other traumatic injury.

• Avascular necrosis (also called osteonecrosis), a condition in which a reduced flow of blood to the top of the thigh bone eventually causes the hip joint to collapse.

Studies have shown that hip replacement is one of the most successful orthopedic surgeries and that people's quality of life is improved by the procedure.

"Simple things, like putting on shoes and socks, are very difficult with arthritis - and this improves that," Asnis said.

RISKS

Hip replacement has been associated with a small risk for serious complications, the most worrisome being infection. Minor infections in the incision area can usually be treated with antibiotics, but major or deep infections may require surgery to remove infected tissue and the artificial joint, according to the American Academy of Orthopaedic Surgeons.

Blood clots also are a threat. People who have hip-replacement surgery usually are given blood thinners, such as aspirin or Coumadin, to prevent clots from forming.

There's also a longer-term risk that the implant will loosen or wear out, said Dr. Daniel Rich, a Manhasset orthopedic surgeon who's an assistant clinical professor of orthopedics at Weill Cornell Medical College in New York City.

"I tell patients we're unhappy if they don't last 10 years, and we're not surprised when they last beyond 20 years, and that depends a little bit on how careful the patient is in taking care of their new hip," he said.

But with more people having hip replacement surgery at a younger age, replacement of the original prosthesis with a new joint - called "revision surgery" - is becoming more common, reports the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases.

REHABILITATION

People are released from the hospital within days after hip-replacement surgery, although it may take three to six months to fully recover, the institute notes.

Rich said he advises his patients to begin a progressive walking program after surgery, with the goal of walking a mile by six weeks.

CURRENT THINKING

New minimally invasive procedures, involving fewer and smaller incisions than traditional surgery, may speed recovery, early research suggests. But long-term outcomes have yet to be established.

Likewise, a technique called hip resurfacing has emerged as an alternative to the total hip replacement, particularly for younger people. With this surgery, the hip socket is replaced but the "ball," or head of the thigh bone, is left in place. Surgeons trim the bone to size and cover it with a metal cap. It's too soon to tell, though, whether this option will prove beneficial in the long run.

THE LONG ISLAND SCENE

Long Island's risk-adjusted infection rate for hip replacements - at 1.2 percent - is on par with national and New York State averages of 1.5 and 1.3 percent, respectively, according to a report on hospital-acquired infections by the New York State Department of Health.

Though regional differences across the state are negligible, hospitals that perform the fewest hip procedures are significantly more likely to have higher infection rates, the report noted.

For the best results, experts recommend looking for a surgeon and hospital that do a lot of hip replacements.

Who's who

This is the ninth installment of a 26-week series in which Newsday presents Castle Connolly's list of top L.I. doctors. Today: orthopedic surgeons

Dr. Scott Alpert

379 Oakwood Rd., Huntington Station, 631-423-4090

Dr. Stanley Asnis

600 Northern Blvd., Great Neck, 516-627-8717

Dr. James Capozzi

1300 Franklin Ave., Garden City, 516-747-8900

Dr. Richard D'Agostino

600 Northern Blvd., Great Neck, 516-627-8717

Dr. David Dines

935 Northern Blvd., Great Neck, 516-482-1037

Dr. Thomas Dowling

763 Larkfield Rd., Commack, 631-462-2225

Dr. Craig Levitz

36 Lincoln Ave., Rockville Centre, 516-536-2800

Dr. Ronald Lewis

Pediatric Orthopedics of LI, 598 Jericho Tpke., Syosset, 516-873-8341

Dr. Thomas Mauri

865 Northern Blvd., Great Neck, 516-918-6300

Dr. Carlos Montero

2920 Hempstead Tpke., Levittown, 516-735-4048

Dr. Daniel Rich

585 Plandome Rd., Manhasset, 516-627-1525

Dr. Nicholas Sgaglione

600 Northern Blvd., Great Neck, 516-627-8717

Dr. Raymond Shebairo

1575 Hillside Ave., New Hyde Park, 516-437-5500

Dr. Barry Simonson

825 Northern Blvd., Great Neck, 516-773-7500

Dr. Richard Tabershaw

375 E. Main St., Bay Shore, 631-665-8790

Dr. Jonathan Ticker

Island Orthopaedics & Sports Medicine, 660 Broadway, Massapequa, 516-798-0111

How they were picked

Castle Connolly Medical Ltd. is a health care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.

Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Newsday is not part of the selection process.

Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.

To see the whole list . . .

Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The soft-cover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.