Medicare Names Best, Worst Hospitals for Hip, Knee Replacement Surgery

A government analysis has identified 95 hospitals that have the worst track record for hip and knee replacement surgery involving elderly patients, and 97 hospitals where hip and knee patients fared best.  

The analysis of hip and knee replacement complications is a product of the Medicare division of the U.S. Centers for Medicare and Medicaid Services (CMS), which is attempting to increase quality at the nation’s hospitals.

Medicare analyzed data for its Hospital Compare website, which allows consumers to look through a database comparing hospitals on a variety of metrics in order to help them select the one best suited for their needs.

Of the 95 hospitals that the study identified as having the poorest outcomes, due to readmission and complication rates, nine topped the list. They were: Froedtert Hospital in Milwaukee; Grant Medical Center in Columbus, Ohio; Mercy St. Anne Hospital in Toledo, Ohio; Northwestern Memorial Hospital in Chicago, Illinois; the Pennsylvania Hospital of the University of Pennsylvania Health System in Philadelphia, Pennsylvania; Peterson Regional Medical Center in Kerrville, Texas; Reston Hospital Center in Reston, Virginia.; Shannon Medical Center in San Angelo, Texas, and Southside Regional Medical Center in Petersburg, Virginia.

There were 97 hospitals that were among the best for hip and knee replacement surgery. About 25 of those hospitals showed lower than average complication and readmission rates. Kaiser Health News has published a list of the best and worst hospitals for hip and knee replacement surgery identified by CMS.

To make its determinations, CMS looked at the likelihood of eight different complications possible following knee and hip replacement surgery. These complications include heart attacks, pneumonia, or sepsis/septic shock in the first seven days after admission. They also include surgical site bleeding, pulmonary embolism or death within 30 days of admission; as well as reports of mechanical complications, periprosthetic joint/wound infection during the first 90 days after admission.

The analysis looked at the results for Medicare beneficiaries aged 65 or older. They compared the rates of individual hospitals to the U.S. national hip/knee complication rate.

Old Data, Bad Implants Could Skew Findings

Some hospitals complained about the rankings, particularly those that found themselves ranking poorly, indicating that CMS used data as old as 2009 for the study, and that in many cases the hospitals had made significant changes to their practices and quality of care since that time.

Another factor that may have affected the findings are complications and revision surgeries linked to defective hip and knee implants, which could have affected the number of mechanical complications suffered by patients.

In August 2010, DePuy Orthopedics, a subsidiary of Johnson & Johnson, recalled more than 90,000 DePuy ASR metal-on-metal hip replacement systems worldwide. That DePuy ASR recall sparked a massive litigation with more than 12,000 DePuy ASR hip lawsuits filed. Last month a DePuy ASR settlement in 8,000 of those cases was announced at a total cost for DePuy of $2.5 billion.

The DePuy ASR recall sparked concerns about an entire class of hip replacement systems known as metal-on-metal hip implants, due to the cobalt and chromium ball-and-socket design. High rates of revision surgery due to complications and catastrophic failures were reported with a number of hip implants.

In addition to claims brought by individuals who received an ASR implant, a number of other metal-on-metal hip lawsuits have been filed against the manufacturers of artificial hip systems that feature a similar design, including DePuy Pinnacle hip lawsuits, Biomet Magnum hip lawsuits and Wright Conserve hip lawsuits.