More than 30 million Americans have osteoarthritis, a common but painful form of arthritis that typically affects joints in the hands, knees, hips, and spine. For patients who have osteoarthritis, symptoms of severe pain and stiffness can be managed through various treatments, but the damage to joints cannot be reversed. Joint replacement surgery is among the most common orthopedic procedures, with more than 650,000 knees and 250,000 hips replaced each year.
Osteoarthritis hip replacement surgery alternatives
A year after having hip replacement surgery, Dorthy Shellorne says she’s glad she chose to have the procedure. She had been an active walker before she developed painful osteoarthritis in her hip. But making the decision to undergo surgery wasn’t easy, and she tried many other non-surgical alternatives to hip replacement surgery first—including hip injections, physical therapy, massage, acupuncture, and prescription medication. None of them helped her osteoarthritis hip pain.
“My doctor told me that hip replacement surgery was an option, but I thought only older people had that surgery,” says Shellorne, who is in her early 60s. What convinced her to go through with the surgery was a decision-aid video that her doctor suggested she watch. It helped her understand her options, and then—with input from her doctor—decide that surgery was the right choice for her.
Shared decision making
The process Shellorne and her doctor went through is called “shared decision making.” In 2009 Kaiser Permanente Washington clinicians began regularly providing patients with decision-aid videos and print materials for common conditions such as prostate problems, low back pain, fibroids, and coronary artery disease. Since then, we’ve distributed some 50,000 decision aids to patients—more than any other health care system in the United States.
“Our shared decision-making aids are helpful for conditions where there are multiple options for treatment that are equally good, but with different risks and benefits,” says Kimberly Wicklund, manager, Health Information and Promotion. “The materials help patients think through their goals and preferences so they’re ready to talk to their doctor and help choose a treatment that really meets their needs.”
“Choosing Wisely encourages conversations between health providers and patients about common tests and treatments that are proven to have little or no benefit and may even be harmful,” says Matt Handley, MD, Kaiser Permanente Washington’s medical director, Quality, and chair of the Washington State Choosing Wisely Task Force. Doctors and other health providers are sharing fact sheets, developed by the campaign, with patients. The fact sheets detail evidenced-based recommendations about the pros and cons of various tests and treatment options.
Studies, including some by the Kaiser Permanente Washington Health Research Institute, have shown that patients who are involved in treatment decisions are more likely to choose conservative, less invasive options, and be more satisfied with their choice, no matter what the outcome.
After trying more conservative options, Dorthy Shellorne is happy with her choice. “Rebuilding muscle strength and endurance is a slow process. But the surgery helped a lot. It was a good decision for me.”