Research and outcomes
Dr. Fisher has been involved in clinical research since 1988, collecting outcomes data on the thousands of hip and knee replacement procedures he and his team have performed over the years. This has provided invaluable data on the performance of different hip and knee implants, the surgical techniques for implanting them, and the recovery and complications that can occur. This has given him the opportunity to provide quality assurance and quality improvement initiatives that have improved the outcomes of hip and knee replacement over the years, from reduced risks of complications such as infection or blood clots after surgery to better pain management and rehabilitation techniques. This effort has led to numerous presentations and publications in the orthopedic field, allowing others to learn from the research we have been doing. This is one of the reasons that we see our patients on a regular basis and want to know of any problems you may have with your hip or knee implant.
Many of our patients have had hip or knee implants in place for over 25 years and continue to return every few years for routine evaluations. We learn a great deal from observing these individuals and the functional outcomes of joint replacement surgery.
While we have tracked our complications yearly and can access this data, as needed, a compilation of the results shows the following. Dr. Fisher’s patients have a risk of infection of 0.1 percent, with total knee patients having a slightly higher risk than hip patients. In general, the risk of this complication is higher in obese, diabetic and immunocompromised patients and lower in otherwise healthy individuals. The risk of a blood clot (deep venous thrombosis- DVT) is around one percent and equally divided between hip and knee patients. Some patients have a greater chance of developing this complication and we screen patients for their risk of this and treat them with some type of blood thinner to reduce their risks. A pulmonary embolus is a blood clot that has traveled to the lungs. While a potentially fatal complication, this is a rare event and has occurred in 0.1 percent of patients. Nerve injury after hip surgery can occur and leave a patient with weakness in the foot. While it can recover over time, it can be a frustrating complication. Our patients have had a 0.1 percent risk of developing this after total hip replacement.
Through outcome and patient satisfaction tools, we have learned that most of our total hip patients 99 percent are very satisfied with their surgery outcome. This compares with total knee patients, who have a lower rate of high satisfaction 94 percent, with an additional four percent mostly satisfied. Multiple studies including our own have shown total knee patients have slightly lower levels of satisfaction due to symptoms of stiffness, clicking, swelling or ongoing discomfort in their knee. This is an area we continue to study and search for ways to improve the outcomes of our patients.