Hip Pain and Functional Loss Symptoms and Strategies For Daily Living Marcus Romanowski, MD

Incidence of Hip Osteoarthritis 14% of adults over 25 years old symptomatic hip OA 35% of adults over 65! 332,000 THR per annum in USA Female to male ratio is 60:40 Average age for THR in US is 64 11 symptomatic months prior to surgery Marcus Romanowski, MD

Pathophysiology of Hip OA Death of chondrocyte Increasing osteophyte at margins Synovial hypertrophy and inflammation Labral degeneration/tear Collapse/subluxation Marcus Romanowski, MD

Symptoms of hip arthritis Groin pain Loss of range of motion, internal rotation is first to go Difficulty donning/doffing shoes Night pain Stiffness upon onset of activity after rest Thigh/knee pain Marcus Romanowski, MD

Conservative Management Options Activity modification Physical therapy/ strengthening & ROM Tylenol NSAIDS- Aleve (naproxen) or Advil (ibuprofen) Corticosteroid injection cane Marcus Romanowski, MD

Making the decision for surgery Am I inconvenienced or debilitated by my pain? Does my pain limit my choice of activity 3 or more days per week? Does night pain prevent restful sleep? Do I fatigue more easily than previously? Rely on cane? Am I stumbling/ risking a fall? Marcus Romanowski, MD

Risks versus Benefits Does my functional loss impact me so much that I am ready to take the risks associated with surgery? Blood clot ( for most this risk is less than one percent) Infection (rare absent predisposing issues, a fraction of a percent) Lesser risks (leg length, dislocation, nerve or vessel injury) Am I ready to invest the time for recovery? 2-3 day hospital stay give up driving for anywhere from 10 days to 6 weeks make my hip a priority for 2 weeks Marcus Romanowski, MD

What to look for… Surgeon Hospital Experience Case volume for the procedure you need Specialist in Joint Replacement Practice Focus- PA, RN Staff Office staff Case volume Accredited Joint replacement unit (Joint Commission Accredited) Disease specific certified for Knee and Hip Replacement RN staff, nursing/ PT culture Marcus Romanowski, MD

Do your homework…. Propublica can help! Just Google “Surgeon Scorecard” https://projects.propublica.org/surgeons/state/NY/procedure/8151 Marcus Romanowski, MD

Propublica Data MARCUS ROMANOWSKI 4510 MAIN ST, BUFFALO, NEW YORK 14226-3800 | 716-839-0632 Related Hospitals: KENMORE MERCY HOSPITAL This Surgeon's Procedures Knee Replacement Hip Replacement Complications Adjusted complication rate Peer ranked performance of complication rate Marcus Romanowski, MD

What about approach? Robotics? Location? Many ways to skin a cat Excellent functional outcome is the goal Clinical studies in USA and globally- 3 items consistently correlate with excellent outcomes Surgeon case volume/ experience Hospital case volume Duration of surgery (shorter is better!) Robotics, Direct Anterior Approach, Ambulatory Joint Replacement All remain yet to be substantiated on quality and outcome measures Marcus Romanowski, MD

Thank you for your attention Visit us at www.bestkneehip.com Marcus Romanowski, MD