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

2. 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

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

4. 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

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

6. 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

7. 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

8. 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

9. Do your homework…. Propublica can help!
Just Google “Surgeon Scorecard”
Marcus Romanowski, MD

10. Propublica Data MARCUS ROMANOWSKI
4510 MAIN ST, BUFFALO, NEW YORK | 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

11. 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

12. Thank you for your attention
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Marcus Romanowski, MD