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Healthgrades has announced the winners of its 2023 Outpatient Joint Replacement Excellence Awards, naming the top spots in the US for outpatient knee and hip replacement procedures. Geber86/Getty Images
  • Healthgrades has announced the winners of the 2023 Outpatient Joint Replacement Excellence Awards.
  • This is their first national quality ratings list for outpatient total knee and total hip replacement procedures.
  • Five-star ratings were given to 146 hospitals for outpatient total knee replacements.
  • Five-star ratings were also given to 78 hospitals for outpatient total hip replacements.

Finding the best doctor and hospital for outpatient joint replacement procedures can be a difficult and stressful process.

On Tuesday, Healthgrades, the leading online resource for comprehensive information about physicians and hospitals aimed to make that process easier by announcing the recipients of their 2023 Outpatient Joint Replacement Excellence Award.

This is their first national quality ratings list for outpatient joint replacement procedures.

To compile the list, they evaluated patient mortality and complication rates for both outpatient total knee and total hip replacements at hospitals nationwide. They broke the national list down by way of three different distinction areas:

  • Healthgrades Outpatient Total Knee Replacement Five-Star Ratings – 146 hospitals received this designation
  • Healthgrades Outpatient Total Hip Replacement Five-Star Ratings – 78 hospitals received this designation
  • Healthgrades Outpatient Joint Replacement Specialty Excellence Award – 112 hospitals received this designation, which represents the top 10% in the United States

“It is imperative that consumers have the information they need to choose a doctor and hospital that excel in their procedure as the market for elective orthopedic care continues to shift towards outpatient settings,” said Dr. Brad Bowman, chief medical officer and head of Data Science at Healthgrades, in a press release. “As a leader in health transparency for over 20 years, Healthgrades is proud to be the first to publish outcomes-based outpatient ratings, and we look forward to expanding our outpatient analysis further later this year.”

Healthgrades’s full list of award winners can be seen here.

Helping Americans make sense of the many options available to them when it comes to orthopedic care certainly answers a great need. According to Healthgrades, 500,000 people on Medicare had an outpatient knee or hip replacement procedure from 2019 through 2021.

To compile their list, Healthgrades used 2019-through-2021 Medicare inpatient and outpatient data that comes from the Standard Analytics Files (SAF) purchased from the Centers for Medicare and Medicaid Services (CMS), according to their website.

Among the findings from their analysis, Healthgrades found that those who received procedures from the hospitals on this new list reported up to a 50% lower risk of experiencing a complication than those people who were treated at other hospitals.

Additionally, people who had a hip replacement at one of the hospitals that received a five-star rating for total hip replacements had a 76% lower risk of experiencing one or more complications.

Those who had a knee replacement at a five-star-rated hospital for total knee replacement had an almost 85% lower risk of experiencing one or more complications.

“If all hospitals performed as well as those with five-stars in outpatient knee and hip replacements, over 10,000 complications could have been avoided,” reads the release.

When asked to contextualize why it is so important to find the right provider for you to perform something like a total knee or hip replacement, Dr. Adam Sassoon, a dual-fellowship trained orthopedic surgeon with expertise in joint preservation/reconstruction and orthopedic traumatology at UCLA Health, told Healthline that you want to make sure this kind of replacement will “last 30-plus years.”

Sassoon, who is unaffiliated with Healthgrades, said that “it’s really important people seek out providers that are very specialized in doing joint replacements.”

“The people that do a lot of total joint replacements, for instance, and really focus on that as the primary portion of their clinical practice also know how to deal with problems that come up along the way and monitor for complications that can occur,” Sassoon explained. “Even though those complications are few and far between, when they occur, they can require further surgeries and those surgeries can be somewhat complex. Selecting a joint surgeon that does not only do primary replacements — the first time [procedure] — but also will do revision arthroplasty, is also important.”

The last thing you would want to do if a joint replacement doesn’t go the way you expected is to go and find another provider and deal with the problem of starting that process all over again, he added. It’s important to find the right provider for you to begin with.

Dr. Mathias P. Bostrom, chief of the adult reconstruction and joint replacement service at the Hospital for Special Surgery (HSS) in New York City, told Healthline that outpatient total joint replacement surgeries are “rapidly becoming an alternative for patients who qualified for outpatient procedures.”

He said the big advantage of these procedures is that you leave the hospital and recuperate in your own home environment without needing to stay in a hospital for an extended period of time. Bostrom, who is also unaffiliated with the new Healthgrades list, cautioned that this option isn’t right for everyone. You often have to be relatively healthy and young enough to qualify for an outpatient joint replacement “and have the right support network” in place.

For those who do qualify, these procedures are as safe as in-patient surgeries as long as all of the proper criteria are met, he added.

He echoed Sassoon that finding the right provider initially is key.

Bostrom said that the most critical thing for any hip or knee replacement is getting it right the first time.

“It’s really important that the institution has a great track record in both inpatient and outpatient surgeries, but it’s also important you pick the surgeon who has the right track record of being able to perform the surgery with the least amount of complications,” he stressed.

We live during a time when great strides have been made in medical advancements in joint care and replacements, especially for people living with arthritis.

Bostrom said seeking a hip or knee replacement surgery — in or out of a hospital — is a major operation. You want it to go well and make sure you don’t just avoid short-term complications but have “an implant that will last as long as possible.”

“If you do it right the first time, the likelihood of it lasting a very long time is really optimized,” he said.

When looking to find the right provider and institution, Sassoon said you can check out a surgeon’s professional profile online and see whether they completed a fellowship that specialized in the area of care that applies the most to you.

For example, he suggests seeing someone who did a fellowship in adult reconstruction or joint replacement as opposed to sports surgery, or if outpatient is important for you, make sure they have a track record performing those kinds of procedures.

“Some [providers] don’t do a lot of outpatient total joint replacement surgery, they’ll have hospital-based practices, so, I think, again, if you’re looking to have a total joint done in an outpatient setting, you should potentially look for someone who also does that in a high volume,” Sassoon explained. “They’ll be really dialed in to provide you with what you need in order to go home successfully on the same day as your joint replacement so that you don’t have to then go into the ER or the clinic a bunch of times.”

Bostrom added that it’s important to pick a good institution that makes sense for your geographic location. Not everyone has the financial means or resources to travel to a top-ranked institution far away from them, like an HSS or a Mayo Clinic, for two examples.

“There are still very top-ranked institutions in most locations,” he said.

Parsing through all of the information online can also be difficult. Bostrom said much of it isn’t “peer-reviewed,” with out-of-date, incorrect information.

“You have to sort through them a little bit word of mouth and take rankings across the board and see how they fared in terms of delivery of care,” he said, when it comes to assessing your options.

Bostrom added that you should never rush into one of these procedures. You should wait for a joint replacement — especially “until the arthritis or the degeneration of the joint is bad enough that it truly interferes with the quality of life.”

For his part, Sassoon added that the American Association of Hip and Knee Surgeons (AAHKS) is one vetted resource that can help you pinpoint the kind of care that might make most sense for you.

“Ask if your surgeon is a member of AAHKS, that can be a helpful feature that can differentiate someone that really specializes in a total joint replacement from someone that just dabbles in it,” he said.