Experience Matters When it Comes to Performing Joint Replacement Surgery
By Dr. William Leone, MD, FACS
If you’re of a certain age, chances are you envision a doctor as an older, bespectacled, white-coated male, perhaps with distinguished-looking salt-and-pepper hair and kind eyes. But when it comes to finding the best doctor for you, how much importance should you assign to age? Do experienced surgeons have the advantage or do their younger counterparts have the edge?
An essay by two medical researchers recently published in the Wall Street Journal generated debate over its conclusion that doctors’ effectiveness generally has less to do with their age than with how many patients they see and how well they keep up-to-date with new research. When it came to evaluating surgeons, Medicare data showed that older doctors performed better across all measures because of their advanced diagnostic skills and technical abilities that depend on years of experience. That being said, the study also concluded that most patients tend to choose their doctors based on things like bedside manner, perceived expertise, responsiveness and other varied and subjective attributes. So, does age matter when selecting a surgeon?
I just returned from the internationally attended American Arthritic Hip and Knee Meeting (AAHKS) held in Dallas, Texas in November 2023. I reviewed a study that also found that high-volume hip surgeons have lower early complications and revision rates than low-volume surgeons. Surgeons were classified as high volume if they performed 150 or more primary total hips a year and low volume if less than 150 total hips a year. High-volume surgeons had significantly lower lengths of stay, high rates of discharge to home, lower 3-month readmission rates, a lower 3-month emergency department visit rate, and lower 3-month infection rates than low-volume surgeons. Similar findings have been reported with high volume vs low volume knee replacement surgeons.
Experience, clinical judgement, and the required surgical abilities develop only from taking care of many, many people over years. Staying current regarding the latest innovations and literature is also critically important.
At The Leone Center for Orthopedic Care, I focus exclusively on hip and knee replacement surgery. Over the course of my career, I have completed more than 15,000 hip or knee replacements and currently perform more than 400 joint replacements per year. Prior to developing this concierge model, I performed more than 600 joint replacements a year. Every hip and knee replacement which I perform has unique subtleties and nuances which must be navigated. The specific goals for each individual’s hip or knee are also unique and often subtle. The more experience I have, the better able I am to recognize subtleties and fine tune my operation. I know that this is why after operating on so many people’s hips or knees over so many years, I’m still getting better and love what I’m doing. Assessing someone before their surgery and then caring for them after surgery also requires this same thorough commitment to detail and excellence. And it too is something we keep “fine tuning” and getting better at.
During my initial consultations with patients, I often field questions about new products and procedures. As a Board Certified Orthopedic Surgeon, I use a range of technologies in my practice, including computer navigation, kinematic sensors and robotics for partial and total knee replacements, and my own invention, the Pelvic Alignment Level (PAL), a device and technique that assists surgeons during Total Hip Replacement (THR) to achieve more precise implant positioning and leg length, to optimize hip mechanics and maximize longevity of a prosthetic joint.
Over the years, I have been involved in clinical trials and reviews of new orthopedic techniques as a consultant for implant, instrument design and clinical application. I also have taken an active role as chairperson and faculty at symposiums that provide continuing medical education for hip and knee surgeons in the United States, Europe, Latin America and the Caribbean, and mentored other orthopedic surgeons, joint replacement fellows and medical and pre-medical students in patient care and surgical techniques.
The brands of hip and knee prostheses I prefer are time-tested and well-documented as safe and effective. Although all of these implant systems have evolved with an increased number of prosthetic sizes, revision applications, and new instruments, their underlying design and principles have been consistent. The Leone Center’s long-term study and use of these prostheses have consistently delivered the best and most reproducible results.
To our patients’ benefit, our specialized, concierge-style orthopedic practice enables us to fine-tune our systems and procedures over the years, making our surgeries highly efficient and requiring less time than they would elsewhere. This does not mean we rush. Rather, it means that because of our experience with these procedures, for example, the surgical incision is open for less time, reducing the risk of potentially dangerous contamination. Because the time to complete the reconstruction is less, the time the body is positioned on the operating room table is less, which decreases the risk of a deep venous thrombosis (DVT). This is a condition in which a blood clot forms in a vein deep inside the body.
If you have the luxury of choosing your surgeon, remember that communication between doctor and patient is paramount, especially during an initial consultation appointment where anxiety can be amplified by deeply held beliefs and fears that many people harbor about seeking health care.
At The Leone Center for Orthopedic Care, my years of experience have shown me how meaningful it is to understand each patient’s concerns about surgery and then aligning the surgeon/patient communication accordingly. An informed patient who knows what to expect helps set the stage for superior outcomes and excellent long-term results and minimizes the risk of complications.
Older or younger is not the question. The most important decision is choosing a surgeon who you feel will produce the best and safest result. Someone who you can connect with and who understands your particular concerns and goals.
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About Dr. William Leone and The Leone Center for Orthopedic Care at Holy Cross Health
William A. Leone, MD, FACS, one of the nation’s top orthopedic surgeons, has operated on thousands of people from all over the world with hip and knee conditions. He takes pride in solving even the most complex hip and knee problems and is gratified by the profoundly positive effect the surgeries he has performed have had on the lives of so many patients.
The Leone Center for Orthopedic Care at Holy Cross Health is located at 1000 NE 56th Street in Fort Lauderdale. For more information or to schedule a consultation, please call 954-489-4575 or visit holycrossleonecenter.com.
