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2018 Meeting of AAHKS – Discussing Practice Decisions

By William P. Barrett, MD on

Dr. Barrett serves as chairman of the education committee for the American Association of Hip and Knee Surgeons (AAHKS), and remains highly involved with continuing medical education. He has been a member of AAHKS since its first year in 1991. As one of the most experienced hip replacement doctors in Seattle, Dr. Barrett performs over 500 joint replacement surgeries annually. For more information about hip and knee injuries, sports medicine, and more, contact Proliance Orthopedic Associates at 425.656.5060.

Several topics were deliberated at the most recent annual meeting of the AAHKS from November 1-4 of 2018 in Dallas, Texas. One of the highlights of the meeting was the audience response session, where Dr. Dan Berry of Mayo Clinic polled the 3,000 joint replacement surgeons in attendance about their practice patterns. This allowed us surgeons to consider the various decisions we make for our patients, and evaluate those practice decisions in comparison to the choices our peers make. These were the different practice alternatives discussed:

Total Hip Replacement (THR or THA)

Approach:
40% of AAHKS surgeons use an Anterior Approach to THR, while 47% use a posterior approach. This is a significant increase in the percentage of surgeons using the Anterior Approach, reflecting it’s increasing popularity and indicating its improved effectiveness.

Fixation:
90% of hips use cement-less fixation, meaning they rely on bone in-growth for fixation of the cup and stem.

Surface replacement:
93% of members do not perform surface replacement due to inferior results.

Head material:
More ceramic heads are used than metal heads, based on age and cost.

Blood clot (DVT) prophylaxis:
87% of surgeons use aspirin for clot prophylaxis after hip replacement.

Outpatient hip replacement:
10% of surgeons perform outpatient total hip replacement.

Outpatient Physical Therapy:
1/3 of surgeons don’t use physical therapy after total hip arthroplasty, while 2/3 use some physical therapy afterward.

Total Knee Replacement (TKR or TKA)

Fixation:
85% of surgeons use cemented fixation, but the use of cement-less fixation is increasing.

Bilateral TKR:
30% of surgeons never do bilateral total knee arthroplasty, while 70% perform them selectively.

Posterior cruciate ligament:
50% of surgeons use a cruciate substituting knee, and 30% of surgeons save the posterior cruciate ligament. This is a highly subjective choice for surgeons.

Alignment:
90% of surgeons use classic neutral alignment, while 10% use “kinematic” alignment.

Patellar resurfacing:
93% of surgeons resurface the kneecap, while just 7% do not perform patellar resurfacing.

DVT prophylaxis:
88% of surgeons use aspirin for clot prophylaxis.

Outpatient TKR:
53% of surgeons never do outpatient total knee arthroplasty, while 47% do perform it on a selective basis.

Use of Physical Therapy:
93% of surgeons use physical therapy after total knee replacement.

Weight limitations:
62% of surgeons restrict their practice to patients with a BMI of 40 or lower for both THR and TKR.

Want to know more about surgeon practice decisions? Contact Dr. Barrett at Proliance Orthopedic Associates for more information on the most up-to-date practices in hip surgery and knee surgery.

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