Hospitals and doctors are not all alike_ they vary in quality due to differences in their training, experience and services. These differences in quality become greater and matter more when you need sophisticated medical care for a complex condition.
For example, a surgeon who performs a complex procedure often, has better success with it than a surgeon who does the same procedure only occasionally. The complication rate and death rate for the same procedure may be many times higher at one hospital than another.
Clearly, the doctor and hospital that you choose have a direct impact on how well you do _ especially when you need an operation as complex as joint replacement.
Joint replacement surgery has gained widespread acceptance as treatment for severely degenerated joints. About 500,000 Americans have surgery to implant an artificial hip, knee or shoulder each year. Three out of every 100 Americans 65 or older have an artificial hip, knee or shoulder.
Osteoarthritis is the leading reason for joint replacement surgery in people over age 60. Younger people may need joint replacement as a result of rheumatoid arthritis or other diseases, or because they have injured a joint while playing sports or in an accident.
A degenerated joint can be extremely painful and disabling, and medical treatment is not always effective. For many people with this condition, joint replacement surgery offers a more positive outlook. Joint replacement can restore mobility; and, in more than 90 percent of patients, it reduces or eliminates pain.
Joint replacement is a complex procedure, and selecting a doctor and hospital for your surgery involves making some difficult and important decisions. No one has more at stake than you; it is one of the most important decisions of your life.
This brochure explains joint replacement surgery of the hip, knee and
shoulder. You may be reading this because you have been told you need an
artificial joint now, or because your doctor has suggested you may need one at
some future time. In either case, you will want to make a decision about where
to go for the surgery based on careful comparisons of doctors and hospitals.
This brochure provides the information to help you do that.
How Do You Judge Quality?
Most of us do more research when we buy a car or a television set than when we choose a doctor and hospital. That may be because we don't know what questions to ask or what to base our evaluation on.
Quality of care can be measured in many different ways, and no universal agreement exists on which should be used. At The Cleveland Clinic Foundation, however, we believe that you can use the following six points, or quality indicators, to compare health care providers:
· Credentials
· Experience
· Range of services
· Participation in research and education
· Patient satisfaction
· Outcome
Choosing a doctor or hospital is often influenced by values. You may want to
go to a hospital that is close to home. You may want a hospital with a specific
religious affiliation. But when you need specialized care for arthritis or other
degenerative joint diseases, you also should consider a doctor's qualifications
and a hospital's outcome record. These quality indicators will help you make
that kind of evaluation.
Sidebar
A Step-By-Step Guide
This guide helps you choose a doctor and hospital by:
· explaining who may be a candidate for total hip, knee or shoulder replacement;
· describing how joint problems are diagnosed;
· explaining hip, knee and shoulder replacement surgery and joint revision surgery;
· explaining six points that indicate quality in performing hip, knee and shoulder replacement and revision surgery;
· providing questions and answers from The Cleveland Clinic Foundation
that you can use to compare doctors and hospitals.
Joint Replacement Surgery
Joint replacement surgery replaces joints that are uneven, worn away or otherwise abnormal with artificial implants. The joints most commonly replaced are the hip, knee and shoulder.
By far the majority of these procedures are performed to relieve the pain and disability that result from osteoarthritis. Osteoarthritis is the wearing away of the joint's surface over time, due to normal use. This disease affects 80 percent of people over age 70, and a significant number of them will eventually suffer severe pain and limited mobility. Osteoarthritis can also occur in younger people, sometimes as the result of an injury or childhood disorder, and can cause the same problems that it causes in older people.
Rheumatoid arthritis and other inflammatory diseases are another common cause of joint degeneration. People with these diseases have a disorder of the immune system that causes it to attack and destroy the joint surfaces. Damage to the joint often causes extreme pain and disability at a younger age in people with rheumatoid arthritis and other inflammatory diseases than with osteoarthritis.
Young people who have developmental problems related to an underlying disease such as diabetes or who have damaged a joint playing sports or in accidents may also be candidates for joint replacement surgery.
How is damage to a joint diagnosed?
Pain is the most common symptom of joint damage and usually the one that brings the person to the doctor. A specialist in bone and joint disorders, who is called an orthopaedic surgeon, can determine the degree of joint damage and its cause by conducting a thorough physical examination and listening to the patient's history of pain and other symptoms, such as problems with mobility or function. X-rays and other imaging techniques are used to determine the extent of damage and whether joint replacement is the appropriate treatment.
How are these problems treated?
Surgery is considered the last resort for treating damaged joints, after all other treatments have been tried. Joint problems should be treated without surgery first, using medication, exercise and physical therapy. When these treatments can no longer effectively control pain, and pain interferes with the person's normal activities, surgery may be considered. Joint replacement is the most common surgical treatment, but other procedures may be used, depending on the problem.
Joint replacement surgery, which is called arthroplasty, involves surgically removing the damaged joint and replacing it with an artificial joint made of metal, plastic or both. The complexity of a joint replacement procedure varies depending on the underlying disease that caused the problem, the patient's age and whether other medical problems are present.
Many types of artificial joints are available. Some are implanted using special cement to lock the new joint to the bone; others are cementless. The orthopaedic surgeon chooses the most appropriate type of replacement joint based on the individual's unique characteristics and needs.
How are complications avoided?
The most important potential complications following joint replacement surgery are infection and blood clots. They are serious when they do occur, but fortunately they are rare. The infection rate has been reduced to less than 1% through precautions such as giving antibiotics prior to joint replacement surgery, using the patient's own blood for transfusions, and taking precautions in the operating room to prevent contamination during surgery.
Medication can also be given after surgery to prevent blood clots that can form in deep veins, a condition called deep vein thrombosis or DVT. Following surgery, diagnostic radiologists at some hospitals now use specialized Duplex ultrasound scanning to detect blood clots so they can be treated before they cause problems.
What happens when joint replacements wear out?
After joint replacement, people can engage in almost any activity except the
most jarring types of exercise, such as jogging. Most of today's artificial
joints are expected to last 15 to 20 years under normal wear. But, in people who
are more active, an artificial joint may wear out sooner. When a joint wears
out, works itself loose or develops a problem, it either can be resurfaced or
removed and replaced in a joint revision operation. Regular X-ray examination of
an artificial joint allows the orthopaedic surgeon to detect and monitor any
changes and plan for revision surgery before a major problem develops.
Where Do You Begin?
Measuring quality in ways that are useful to consumers is a new idea in health care. Because of that, it may not be possible to get complete information for each of these quality indicators. But the willingness of providers to give you as much information as possible is a good sign. It shows that they are dedicated to maintaining and improving their quality, responsive to patients, and confident of their capabilities.
If you have severe joint pain that does not respond to conservative medical treatment, ask your doctor about a referral to an orthopaedic surgeon, a physician who specializes in bone and joint surgery. Get the names of several doctors and hospitals that have the most experience in joint replacement surgery.
You will likewise want to compare doctors and hospitals if you need to have an earlier joint replacement redone. Surgical revision is technically more difficult than the initial replacement and the risks of infection and other problems are higher, so the doctor's and hospital's experience are very important. If you have multiple medical problems, you will want to select a hospital that has the capability to evaluate and treat or control all of your problems before, during and after surgery.
Ask the questions we suggest. Make comparisons. Then make your decision. Be
an informed consumer for yourself and your family.
Sidebar
Getting a Second Opinion
If a degenerative joint problem is causing you significant pain or interfering with your normal activities, you may be a candidate for joint replacement or another procedure to reconstruct your joint.
Our orthopaedic surgeons welcome people seeking a second opinion. They can
determine if joint replacement may help your particular problem or if another
type of surgery or medical treatment would offer a better solution.
How to Use Quality Indicators
How can you use these indicators to judge if one doctor or hospital is better for you than another? By combining information from more than one quality indicator, according to a report, "The Quality of Medical Care: Information for Consumers," produced by the U.S. Congress, Office of Technology Assessment.
According to the report, patients about to have surgery can be confident if the hospital performs a high number of surgeries, has a low mortality (death) rate, and if the surgeon has extensive training and experience in the procedure.
On the other hand, the report states "...if a hospital has a high
mortality rate and a low volume of procedures, the patient might wish to
question the surgeon about that hospital and about alternatives, even if other
hospitals require longer travel."
1. Credentials
Do the doctor and hospital measure up?
Credentials have been set by nationally recognized medical professional organizations to verify that doctors and hospitals meet certain standards in health care delivery.
Doctors:
Board certification, or the international equivalent, is a sign that doctors are highly trained in their fields. Doctors who specialize, such as orthopaedic surgeons, should be board certified in the specialty in which they are practicing. Each specialty has a national board that is responsible for setting standards doctors must meet in order to be certified. Doctors who are board certified in their specialties have completed the amount of training that the specialty board requires, have practiced for a specified number of years in that specialty and have passed a difficult examination in their specialty area. Some excellent doctors are not board certified. Board certification, however, is generally a good indicator of competence and experience.
Hospitals:
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is the nationwide authority that surveys hospitals. The JCAHO decides whether a hospital gets, keeps or loses accreditation based on its meeting certain criteria for staffing, equipment and facility safety requirements. Although accreditation is voluntary, most hospitals go through the process. If the hospital that you are considering is not accredited, it is important to know why.
Some of the best hospitals are often in the public spotlight for their
medical advances and the quality of their care. Information about a hospital's
reputation is widely available through the mass media, listings, the government,
consumer groups, books and magazines such as U.S. News & World Report.
Sidebars
For information about a hospital's status, call the Joint Commission on
Accreditation of Healthcare Organizations at 708/916-5800.
One of America's Best
· U.S. News & World Report has named the Cleveland Clinic one of "America's Ten Best Hospitals" every year since 1990.
· Every year since 1991, U.S. News has identified the Cleveland Clinic as a top hospital in the country for treating orthopaedic disorders.
· The April 1993 issue of American Health named the Clinic among the top medical centers in the country.
· Modern Healthcare magazine named the Cleveland Clinic to its 1994 "Top
100" list of the best-performing hospitals. The Clinic was one of 15
institutions named in the category "Major Teaching Hospitals of 400 or More
Beds." According to the study, if all U.S. hospitals performed at the level
of these 100 hospitals, it would save $21.6 billion a year, trim a full day off
average inpatient stays, reduce mortality an average of 17% and decrease
complications 14%.
Q&A
Are the orthopaedic surgeons board certified?
All Cleveland Clinic staff orthopaedic surgeons are board certified in orthopaedic surgery. In addition, they have subspecialty training and years of experience in joint replacement surgery.*
Have the doctors been recognized for excellence?
Six Cleveland Clinic orthopaedic surgeons are mentioned in the book, The Best Doctors in the Midwest. The Cleveland Clinic also has more physicians who are members of the American Academy of Orthopaedic Surgeons than any other hospital in the state.
Are the diagnostic radiologists board certified?
All Cleveland Clinic staff diagnostic radiologists are board certified.*
Is the hospital accredited by JCAHO?
Yes. The Cleveland Clinic has JCAHO accreditation.
Has the hospital been positively and consistently recognized for medical excellence and leadership?
Yes. The Cleveland Clinic is often named among the top medical centers in
the country. Some of the publications that have recognized the Clinic for
excellence are listed in the box at the left.
*Board certification or its international equivalent became a requirement at
the Cleveland Clinic in 1989 for doctors being appointed to the medical full
staff.
2. Experience
Does practice make perfect?
In the case of a complex surgery such as joint replacement, the more experience the doctors and hospital have, the better the results usually will be.
While joint replacement has become a widely accepted and often used treatment in the past 25 years, it is still a very specialized procedure that should be performed only by surgeons with special training and experience. An experienced orthopaedic surgeon who performs many joint replacements or revisions generally is technically more skillful and can perform the operation more quickly than a surgeon who performs joint replacement or revision only occasionally.
Doctors and hospitals with experience in joint replacement are more likely
to prevent complications such as infection or blood clots and to be able to
treat them if they do occur. An experienced surgeon who has handled many cases
is prepared for the most difficult problems that may arise during the operation
and recovery period.
Sidebar
Experience Counts
According to the American Academy of Orthopaedic Surgeons (AAOS): "The surgeon's experience, training and specialization in total hip arthroplasty are thought to have an important effect on the results of the operation."
The AAOS also notes the following: "The volume of operations that are
done at an institution is a strong determinant of mortality from total hip
arthroplasty, and it is likely that volume also correlates with differences in
operative results and complications."
Q&A
How many hip replacements are performed at the institution in a year?
In 1994, the most recent year for which data is available, Cleveland Clinic orthopaedic surgeons performed 294 hip replacement surgeries, one of the highest volumes in the country.
How many knee replacements are performed at the institution in a year?
In 1994, the most recent year for which data is available, Cleveland Clinic orthopaedic surgeons performed 465 knee replacement surgeries, one of the highest volumes in the country.
How many hip and knee revisions are performed at the institution in a year?
In 1994, the most recent year for which data is available, Cleveland Clinic orthopaedic surgeons performed more than 176 hip and knee revisions, one of the highest volumes in the country. Many of these procedures were done for patients who underwent the initial joint replacement at another hospital and were referred here because a problem had developed.
How many shoulder replacements and revisions are performed at the institution in a year?
In 1994, the most recent year for which data is available, Cleveland Clinic orthopaedic surgeons performed 66 shoulder replacement and revision surgeries, one of the highest volumes in the country.
How long has the hospital been performing joint replacement?
The Cleveland Clinic has been performing joint replacement surgery since
1970 and was among the first 10 institutions approved by the federal government
to perform joint replacement.
3. Range of Services
What services are available?
Hospitals with a broad range of services can treat more complex medical conditions and better handle complications that may occur. If complications arise, you want the best medical care available, and you want it immediately.
Range of specialty departments
Patients undergoing joint replacement surgery often have other medical problems such as high blood pressure, heart disease or other heart or lung problems that need to be identified and treated before surgery. To manage these preoperative concerns, as well as any related complications that may arise during surgery, immediate access to a full range of specialty departments within a facility is critical. Patients with the most complex joint problems have a greater chance for the best outcome at institutions where specialty care is readily available.
After joint replacement surgery, patients require many different services that may include a short stay in a rehabilitation unit for intensive physical therapy and orthopaedic care (known as sub-acute care), home health care, and outpatient physical therapy and occupational therapy. Having all of these specialties and services available in one facility improves continuity of care and simplifies discharge planning.
Some individuals have more generalized forms of disease such as rheumatoid arthritis, lupus and psoriatic arthritis. In addition to affecting the hips, knees and shoulders, these conditions may affect the spine, elbows, hands and feet as well. Therefore, these individuals often require management with systemic medications and are best treated by physicians who specialize in rheumatology. When surgery is necessary, the rheumatologist works with the orthopaedic surgeon to provide the best care for these patients.
Range of treatment options
Some people with degenerated, painful joints may be better treated without
surgery. For patients with certain problems, another type of joint
reconstruction may be a better choice than joint replacement. And some patients
who undergo joint reconstruction may require bone transplantation to supplement
their own bone tissue. For these reasons, it is important to choose a facility
that can treat joint problems in a variety of ways. That way you will get the
most effective, appropriate and cost-effective treatment available.
Sidebar
Coordinated, Comprehensive Care at The Cleveland Clinic
Registered nurses with advanced training in orthopaedic surgery nursing play an important role in coordinating patient care from pre-admission to discharge.
Before admission, a nurse clinician coordinates comprehensive physical examinations to bring to light any medical problems that need to be treated or controlled before surgery. They also make arrangements with the patient to draw blood and have it stored at the Cleveland Clinic. Using the patient's own blood during surgery, a technique known as autotransfusion, is an important way to decrease the risk of infection.
Discharge planning begins as soon as an admission date is scheduled. The care and rehabilitation that are provided after discharge are essential in helping patients regain mobility and function as rapidly as possible.
The nurse determines what services may be needed based on the patient's
general health status, support system, and the complexity of the planned
operation. Services may include physical therapy, occupational therapy, home
health care, or a stay in the Cleveland Clinic's Subacute Care Unit for
short-term intensive skilled nursing and rehabilitation following discharge. The
nurse works closely with the patient and family to arrange the most convenient,
cost-effective solutions.
Q&A
Is help available from a full range of specialty departments?
The Cleveland Clinic's 600 physicians _ all on staff full time _ provide care in more than 100 specialties and subspecialties, including rheumatology, orthopaedic surgery, radiology, cardiology, geriatrics, pulmonary medicine and hypertension. All of these specialties in addition to the Cleveland Clinic Children's Hospital are present in one facility, so prompt multidisciplinary consultation, diagnosis and treatment are readily available.
Does the hospital offer a variety of options for diagnosing and treating joint problems?
The Cleveland Clinic offers a comprehensive range of options for diagnosing and treating joint problems due to arthritis and other rheumatic diseases:
X-ray
MRI
Drug therapy
Physical therapy
Occupational therapy
Orthotics and prosthetics
Biomechanics
Sub-acute Care Unit for short-term rehabilitation
Rehabilitation
Home health care
Bone bank
Autotransfusion
Duplex scanning by ultrasound for blood clots (deep vein thrombosis) after surgery
Preventive antibiotic therapy to prevent infection
Preventive anticoagulant therapy to prevent blood clots
Operating room infection control procedures
Joint reconstruction surgery
Joint replacement surgery
Joint revision surgery
A Rheumatology Department to treat more generalized forms of joint disease
4. Participation in Research and Education
What type of hospital is it?
Selecting a hospital that combines patient care with research and education offers many advantages.
Ideally, the individuals engaged in patient care, research and teaching are organized around a given disease or class of patients, facilitating the sharing of knowledge, research and clinical findings. This approach results in the most rapid transfer of basic scientific knowledge from the laboratory to care delivered at the patient's bedside.
Those individuals on the staff of such a hospital are exposed to an important interchange of ideas. They are also exposed to the newest treatments and technology. At teaching hospitals, physicians are available 24 hours a day.
Choosing a teaching hospital for your care may offer other advantages as
well. Private, not-for-profit teaching hospitals had lower mortality rates than
other types of hospitals, a study in a December 1989 issue of the New England
Journal of Medicine suggested.
Q&A
Is the hospital associated with a teaching program?
Yes. Incorporated in 1935, The Cleveland Clinic Educational Foundation sponsors one of the nation's largest physician postgraduate training programs and is affiliated with The Ohio State University College of Medicine.
Does the hospital have a fully accredited residency training program in orthopaedic surgery?
Yes. The Cleveland Clinic offers a fully accredited five- year residency training program in orthopaedic surgery. For physicians who complete the orthopaedic surgery residency, the Clinic offers a fellowship in adult reconstructive surgery.
Does the hospital conduct basic research or clinical trials related to joint disorders?
Basic laboratory research projects related to joint replacement being conducted at the Clinic include:
· Ongoing studies that investigate how the shoulder moves that will help improve the design of artificial shoulder joints and surgical replacement and repair techniques
· Studies that evaluate how the amount of cement used in hip replacement affects the life and functioning of the artificial joint
· Investigation into the design, materials and body's acceptance of artificial joints
Clinical research projects under way at the Cleveland Clinic include:
· Studies to determine the safest, most effective drug to prevent blood clots after joint surgery
· A patient outcome study to evaluate the success of shoulder replacement surgery
· Investigation into nerve malfunction possibly under- lying shoulder instability in patients without shoulder injury; and
· A study to evaluate the accuracy of a single sequence MR examination
for rotator cuff tears
5. Patient Satisfaction
Is everybody happy?
If you ask one person about his or her experience with a doctor or hospital, you get one person's point of view. Patient satisfaction surveys allow you to judge quality based on the experience of many previous patients. This provides you with a more objective measure to use.
Most hospitals routinely use surveys to learn if patients are satisfied with their medical experiences. The hospital can use these results to improve its services.
Patient satisfaction often reflects the personal side of care. Surveys ask questions such as, How willing are the doctors and nurses to listen? Do they answer questions and explain treatments? How much time does the doctor spend with the patient? Is the hospital clean? Is the food good?
Patient satisfaction information can predict what your experience in a
particular hospital is likely to be.
Q&A
Would patients treated at this hospital recommend it to their family and friends?
97% said they would recommend the Cleveland Clinic to a friend or relative for joint replacement surgery.
How satisfied are outpatients with the overall medical care they receive from the doctors, nurses and other health care providers at this facility?
96% of patients being treated as outpatients in the Department of Orthopaedic Surgery at the Cleveland Clinic said they were satisfied with their experience.
99% said they would return if they needed further medical care.
Is there a program to help patients and their families with the difficulties that may arise during a hospital stay?
Cleveland Clinic patients may call an ombudsman _ another name for a patient-relations representative _ if they have concerns about their care.
Patients in the Cleveland Clinic hospital may dial a 24-hour Helpline from
their hospital rooms if they have any problems, questions, suggestions or
concerns related to service.
6. Outcome Indicators
What are the risks?
Many different outcome indicators can be used alone or in combination to measure the success of treatment and the risks associated with it. The appropriate indicators to use depend on the treatment or procedure being done. For joint replacement and revision, the measures that give the best indication of risks and how well patients do after surgery are explained here.
Quality of Life Outcomes
The degree of improvement in patients' pain and in their ability to perform normal activities can be used as an outcome measure in joint replacement and revision surgery. If patients are free from pain and can perform their normal and desired activities better after the surgery than before, they have gained improvement in their ability to function and in their quality of life.
Mortality Rates
Any operation requiring general anesthesia always carries a risk of death. The risks associated with anesthesia increase with age and with the presence of other medical problems such as heart disease. A thorough evaluation before an operation to identify other medical problems and the appropriate treatment to control them reduces the risks associated with joint replacement or revision surgery.
Infection Rates
Infection is an uncommon complication of joint replacement or revision surgery. When it does happen, however, it can have serious consequences. The best treatment for infection is prevention. A hospital's infection rate indicates how well the orthopaedic surgery team does at preventing infection following an operation. In general, major referral centers use preventive measures most effectively and generally have the lowest postoperative infection rates. If the need for a transfusion arises, using the patient's own blood _ stored before surgery _ is another way to help avoid blood borne infection. At some major centers with a great deal of expertise in shoulder reconstruction, the need for transfusion during shoulder surgery may be avoided entirely.
DVT Rates
Blood clot formation in deep veins, a condition called deep vein thrombosis or DVT, is one of the most common complications of joint replacement or revision surgery for hips and knees. It is not a concern with shoulder replacement or revision. Blood clots can travel to the lungs where they can be serious, even fatal. Most hospitals now treat patients with clot-preventing drugs after surgery to decrease the risk of a DVT forming. But, this is no guarantee that a DVT will not occur.
Specialized scans can detect a DVT and identify its exact location. When DVTs are detected in this way, they can be treated by medication before they cause problems. Not all hospitals scan for DVTs after surgery. It is important to find out from any hospital you are considering whether they use this specialized scan.
Hospitals that do not scan may report lower DVT rates, but this is because many of their DVTs go undetected. A hospital with a higher DVT rate, on the other hand, is probably performing screening to identify and treat DVTs before they cause problems.
Making Comparisons
If you are having joint replacement or revision surgery, ask the doctor and the hospital for their mortality and complication rates and patient ratings of quality of life after surgery. Try to compare rates for patients most like yourself. It is important to try to compare apples to apples so that you know what your risks really are. This may be difficult, however, because complication rates may be reported differently. If a doctor or hospital cannot give you mortality rates or is reluctant to give information, look at alternatives.
Using Cleveland Clinic Data
On the following pages, we provide Cleveland Clinic outcome data for total hip, knee and shoulder replacement and revision.
· Our quality of life outcomes come from more than 550 patients who underwent hip, knee or shoulder replacement or revision at the Cleveland Clinic in 1993. They were surveyed by telephone two years after surgery.
· Mortality and complication rates Cleveland Clinic data is from the Cleveland Clinic Quality Indicator Program (QUIP), a program to help assess and improve the quality of care we provide. Data is based on more than 800 patients of all ages who underwent these procedures at the Cleveland Clinic in 1994.
Whenever possible, we include comparative data from all U.S. hospitals and from the nine other hospitals rated by U.S. News & World Report as the best in the country for orthopaedic care. Comparative data for these hospitals is available for Medicare patients only. To make sure you are comparing apples to apples, the Clinic data presented in the comparison charts also is for Medicare patients only.
Medicare data is reported by diagnostic-related groups (DRGs). Hospitalized
Medicare patients' conditions are divided into 450 of these major diagnostic
categories. DRGs 209 and 491 contain data for joint replacements and revisions.
Q&A
Quality of Life Outcomes
How many patients who had joint replacement or revision at this hospital feel that the surgery improved their quality of life?
More than 550 patients who underwent joint replacement or revision surgery at the Cleveland Clinic in 1993 were surveyed in 1995, two years after their operation. Of these 550 patients, 37% were age 64 or under; 56% were age 65 to 79; and 7% were age 80 or over. This is what they had to say about their quality of life and ability to function after joint replacement or revision:
94% said it lessened their pain.
94% said it allowed them to perform their normal activities.
87% said they performed as well as or better than their expectations.
Of those patients who were unable to perform their normal activities, conditions unrelated to their joint problems were usually the cause.
Overall, 94% of patients said they were better off having had the surgery.
Q&A
Hip Replacement and Revision Outcomes
What is the hospital's mortality rate associated with hip replacement and revision for patients of all ages?
In 1994, the Cleveland Clinic's mortality rate for hip replacement was 0.0%; for hip revision it was 0.0%.
What is the hospital's infection rate following hip replacement and revision for patients of all ages?
In 1994, the Cleveland Clinic's infection rate following hip replacement was 0.0%; for hip revision it was 0.9%.
What is the hospital's rate of deep vein thrombosis following hip replacement and revision for patients of all ages?
In 1994, the Cleveland Clinic's deep vein thrombosis rate following hip
replacement was 8.5%; for revision it was 6.0%. The Clinic scans every patient
for DVT following surgery.
Chart
Medicare Mortality Data:
Hip Replacement*
Cleveland Clinic 0.0%
National 0.7%
U.S. News 0.1%
Medicare Mortality Data:
Hip Revision*
Cleveland Clinic 0.0%
National 1.1%
U.S. News 0.4%
* Medicare patients age 65 and older.
Q&A
Knee Replacement and Revision Outcomes
What is the hospital's mortality rate associated with knee replacement and revision?
In 1994, the Cleveland Clinic's mortality rate for knee replacement was 0.0%; for revision it was 0.0%.
What is the hospital's infection rate following knee replacement and revision?
In 1994, the Cleveland Clinic's infection rate following knee replacement was 0.3%, for revision it was 0.0%.
What is the hospital's deep vein thrombosis rate following knee replacement and revision?
In 1994, the Cleveland Clinic's deep vein thrombosis rate following knee
replacement was 13.4%; for knee revision it was 8.5%. The Clinic scans every
patient for deep vein thrombosis following surgery.
Chart
Medicare Mortality Data:
Knee Replacement*
Cleveland Clinic 0.0%
National 0.2%
U.S. News 0.1%
Medicare Mortality Data:
Knee Revision*
Cleveland Clinic 0.0%
National 0.3%
U.S. News 0.0%
* Medicare patients age 65 and older.
Q&A
Shoulder Replacement and Revision Outcomes
What is the hospital's mortality rate for shoulder replacement?
In 1994, the Cleveland Clinic's mortality rate for shoulder replacement was 0.0%.
What is the hospital's infection rate for shoulder replacement and revision?
In 1994, the Cleveland Clinic's infection rate following shoulder replacement and revision was 0.0%.
How many patients require blood transfusion during shoulder replacement and revision surgery?
The Cleveland Clinic is one of very few medical centers with the capability
to perform these shoulder procedures without the need for blood replacement.
Chart
Medicare Mortality Data:
Shoulder Replacement and/or Revision*
Cleveland Clinic 0.0%
National 0.4%
U.S. News 0.0%
* Medicare patients age 65 and older.
Pioneering Work in Joint Replacement
The Cleveland Clinic Foundation is recognized internationally for its contributions to the field of joint replacement surgery. Doctors here have pioneered many advances:
· The Cleveland Clinic was among the first 10 centers in the country approved by the Food and Drug Administration to perform joint replacement surgery.
· The Cleveland Clinic is one of a handful of medical centers in the country performing fresh osteochondral allografts _ knee transplantation _ for patients with knee fractures that have not healed properly.
· Clinic specialists pioneered treatment for infected artificial knees using a combination of antibiotics, surgical debridement and reimplantation if necessary.
· The Cleveland Clinic has expertise in complex joint reconstruction for bowlegs and knock-knee.
· Department members frequently collaborate with medical prosthesis manufacturers in the design, development and testing of new types of artificial joints. Many of the prostheses first tested at the Cleveland Clinic are now used worldwide for joint replacement.
· Clinic surgeons have pioneered joint replacement techniques for people with lower than average amount of bone tissue using bone grafts.
· The Cleveland Clinic is one of a limited number of facilities in the United States with experience in less-invasive arthroscopic elbow and shoulder surgery for the removal of spurs and loose bone fragments.
· Clinic orthopedic surgeons have developed improved surgical
techniques for hip, knee and shoulder replacement and revision surgery.
Sidebar
For an Appointment
or Information
To make an appointment with a Cleveland Clinic orthopaedic surgeon for consideration for possible joint replacement or revision, please call:
216/444-BONE
(444-2663) (in Cleveland)
800/223-2273, ext. 42663 (toll-free outside Cleveland)
If you would like to receive any other guides in our series, "How to Choose a Doctor and Hospital for Your Treatment," you may call one of these numbers:
216/444-8919 (in Cleveland)
800/545-7718 (toll-free outside Cleveland)
Cleveland Clinic Florida
Cleveland Clinic Florida offers a corresponding program of outstanding
medical and surgical care for patients with disabling joint diseases. For more
information or to make an appointment at Cleveland Clinic Florida, call
800/359-5101.
Reprinted with permission by: Med Help International