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I come from a generation who often sing that famous line from the Rolling Stones song I can't get no -- satisfaction, which leads me to ask: how often are people happy with their results after a hip replacement? I'm not going to do it unless I feel really, really confident that I'll be more than satisfied with the results. What do you think?

According to a recent review article by a group of orthopedic surgeons from The Ohio State University, satisfaction rates with hip and knee replacements are good-to-excellent for most patients. Satisfaction with results has steadily improved over the years thanks to modern surgical techniques, surgical tools, surgeon expertise, and overall improved care. However, anyone going into surgery of any kind must be aware that problems can develop. Just what are the risk factors that put patients in danger of complications, problems, and adverse events associated with total hip arthroplasty (THA)? Heart disease is the number one health problem that complicates elective surgery. Three-fourths of all major problems after joint replacement surgery (hip or knee) are directly linked with the cardiovascular system. High blood pressure, blood clots, valve disease, heart attacks, previous history or heart surgery such as the implantation of a stent or balloon angioplasty top the list of significant (and potentially life-threatening) risk factors. Other health conditions surgeons must watch for in patients considering total hip replacement include rheumatoid arthritis (RA) with psoriasis (skin lesions increase risk of infection, drugs for poor wound healing), organ transplantation, alcohol abuse, HIV, obesity, blood clotting disorders, and eating disorders or malnutrition. Even things like dental disease (cavities, abscesses, gingivitis) can put you on the sidelines. And there's more! Tobacco use (especially smoking), kidney disease, sleep apnea, history of cancer, long-term use of steroid medications, diseases of the blood vessels in the legs, diabetes, and lung diseases must all be taken into consideration as potential risk factors. The authors carefully describe the details of each category of risks and the possible influence these factors have on adverse events after hip replacement. Finally, it may seem like anyone of any age can get a hip replacement. But older age does put adults at increased risk for medical complications (and death) associated with joint replacement. Sixty-five years of age seems to be the cut-off point for low-to-high risk. Risk starts to increase after age 65 to the point that by age 85, the risk of death after hip replacement is nine times higher in adults 85 and older. Paying attention to risks before agreeing to perform surgery is called risk stratification. This is something surgeons are giving more and more attention to as older adults who have multiple health problems ask for joint replacements. Having heard all the possible things that can go wrong, please know that surgeons and hospital staff do everything they can to prevent problems and minimize complications. In fact, with the new upcoming pay-for-performance Medicare program to control costs, surgeons will be penalized for poor results and rewarded for good outcomes. That means patient selection (choosing patients likely to have the best results) will become increasingly important. And the opposite is true, too -- identifying patients at increased risk for complications with surgery will dictate who might not qualify for the procedure. The final challenge for surgeons in this regard is the fact that less than half of all patients who end up with life-threatening complications after surgery have any obvious risk factors beforehand. More studies are needed to provide an evidence-based risk stratification model that can be used to prevent and reduce all post-operative problems, but especially life-threatening complications. Your safety is your surgeon's number one priority. Patient satisfaction is important, too. Be sure and have a frank discussion with your surgeon about your goals and concerns so that you can go into this with confidence that everything will be done to meet your expectations.

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