Minimally Invasive Hip Surgery

Once you learn about the advantages of Anterior and SuperPATH minimally invasive joint replacement surgery (no hospital, no COVID-19, no infections, no blood clots, no heavy pain medications, and most of all, #norestrictions) nearly everyone wants to have it. If it’s affordable. So, how much does Anterior and SuperPATH minimally invasive joint replacement surgery cost?

What matters to you is the cost to you. But before we get to that, I would like to explain what all you are getting for your money. An operating room that can support safe Anterior or SuperPATH minimally invasive joint replacement surgery costs around $1.5 million. The Hanna bed, general anesthesia machines, spinal setup, medications, ventilation, instruments, and their sterilization are all prerequisite. For centers like Phoenix Spine and Joint that use a robot, there is an added cost of the robot. The Stryker Mako robot sells for $1.25 million for the robot itself, and an added $100,000 service contract is needed every year as well. The robot also uses $1,000 in extra disposable equipment for each case. The cost of the actual implant varies; however, typically the purchase price tag is around $5,500. Some facilities also use x-ray in the operating room to perform a digital analysis ($75,000 with an added $50,000 service contract) to be sure the implant is perfectly positioned. So, if you add it all up, it costs your facility around $3 million to get up and running, and an added $1 million a year to keep going.

The next thing you must consider before figuring out your cost is the sticker price. Every facility has its own sticker price for these procedures. For example, at Phoenix Spine and Joint we found the 80th percentile of charges for these procedures in our area is about $99,000. Our patients rank our services in the 99.8th percentile! But we thought the 80th percentile is a fair price, so that is what we set.

The cost to you is also more than just the facility. You must pay the surgeon, anesthesiologist, and for any tests that are needed to make sure you are medically fit for the procedure.

Just like when you are buying a car, when you are buying a medical procedure you usually do not pay the sticker price. The cost to you depends on your situation. There are four common situations to consider. Pick the one that describes you and you can ignore the other three.

• You are over 65 years old and on Medicare. The Medicare insurance pays 80% of Medicare’s fee for a surgery. For a hospital Medicare sets the fee at $22,500 and pays 80% of that. Medicare sets your surgeons fee at $1200 and pays 80% of that. Your anesthesiologist’s fee depends on what is done and how long it takes but it is usually around $500. Most patients with Medicare today have a supplement which pays most of the remaining 20%. A lot of Medicare patients also are on Medicare advantage, so they do not have much added expense.

  Of note, like any other insurance company, Medicare decides what it will and will not cover. At the present time Medicare will not cover total hip replacement in an ambulatory surgery center. Medicare will cover total knee replacement. It is widely expected that Medicare will cover hip replacement in the coming years. But until they do, Medicare patients are cash pay if they want to have total hip replacement in an ambulatory surgery center.

• You have commercial health insurance. If you have commercial health insurance, then your cost depends on your policy. For an HMO you will not be able to choose any surgeon, but your cost may be zero. Better surgeons, like those who perform Anterior and SuperPATH minimally invasive joint replacement surgery, as often not part of an HMO. If you have a PPO then you will have a broader choice of surgeons, but your cost will be greater. The first thing is you will have to pay your deductible. Once that is reached you will have to pay your part up to your policy’s out of pocket maximum. Most insurance policies have 80% co-insurance. That means after the deductible you must pay 20% of the charge from the deductible to the out of pocket maximum.
• You have no insurance and you are paying cash. The “cash price” for Anterior and SuperPATH minimally invasive hip replacement surgeries vary by facility. Most offer a bundled rate that includes the facility, anesthesia, medications, walker, surgeon. At Phoenix Spine and Joint we everyone should be able to afford the best. We, therefore, have a sliding scale for our bundled price which ranges from $22,500 to $99,000. If you ask for it, we can offer you a charitable deduction based on your income.
• You have been in an accident and are on a lien or an industrial injury. In these cases, your cost is zero. The lien or workman’s compensation insurance pays the bills.

Sound confusing? It certainly is. If you have read this entire article and still have the same question as to when you started: how much it costs to have joint replacement, then I would recommend calling Phoenix Spine and Joint. An expert representative will take your insurance information, analyze your benefits, and let you know the answer to this, particularly important question. There is no charge for a cost estimate of this type.

Marty cancelled the Calgary stampede before COVID. Even though he’d been racing pony carts since he was a boy, he knew he couldn’t participate this year. He could barely walk!

As a cowboy, Marty is no stranger to pain. The pony carts reach speeds of 40 mph, and there’s very little between the driver, the back of the horse, and the ground. A friend of his who rides bucking broncos said he’d never be crazy enough to get on one of those carts. But arthritis in his hip had reached the point that Marty wasn’t just worried about not participating in the rodeo anymore, he was being left behind in his own life.

Marty’s first step was to check in with his doctor and find out the options. After an x-ray the doctor told him he had arthritis and would have to learn to live with it. Three months later what Marty was doing didn’t feel like living.  He found an orthopedic surgeon near his home and underwent a consultation. The surgeon confirmed he was a good candidate for total hip replacement surgery, but he would have to wait. A few months after that the pain in Marty’s hip, back, and groin was so severe every time he walked that he was done waiting.

Phoenix Spine and Joint showed up on an internet search as having a program just for Canadians like Marty. The price of the procedure includes all routine services and is guaranteed. After a teleconference with his surgeon, Marty was determined to come down to Phoenix and have minimally invasive hip replacement surgery. His wife came with him on the trip down to help.

Marty walked into the ambulatory surgery center in that morning and walked out after lunch with a new hip. His surgeon went over the procedure and answered all his questions. The surgery took less than an hour. He doesn’t remember much of the spinal anesthetic, but he had no trouble walking up. His usual pain was gone when he woke up. He and his wife took a shuttle to the hotel and he took it easy for the rest of the night.

They gave him a walker at the ambulatory surgery center, but Marty hardly touched it. He didn’t need to. He didn’t take the pain pills, either. He didn’t need to. The hardest part of the first week of recovery for Marty was not doing too much. After years of pain from osteoarthritis of the hip, he was ready to go! One-week later Marty was cleared to return home on his post-operative visit.

Marty managed to take it easy for a month after his SuperPATH hip replacement surgery, then he gradually returned to full activity. Like the anterior hip replacement surgery, the SuperPATH procedure has no restrictions and no precautions. Additional physical therapy is not required.

It’s been six months since Marty’s minimally invasive hip replacement surgery. If COVID hadn’t canceled the Calgary Stampede this year Marty was ready to compete. Next year, Marty. And hang on to those reins around the corners!

The location of the scar for anterior hip replacement surgery is changing for the better! 

These days it seems like everyone who needs hip replacement surgery wants to have an anterior approach; but we’ve never met a patient who likes the incision. No one wants their muscles cut during surgery. Muscles make you strong. By sparing your muscles anterior hip replacement surgery keeps your hip strong, has a quicker recovery, and reduces the risk of hip dislocation which can happen after hip replacement surgery. But the incision for anterior hip replacement runs right down the front of the thigh.

It’s not just that it looks bad; a scar down the front of your thigh is hard to heal. Surgeons have obsessed over scar healing for a hundred years. They found that skin incisions heal best when they are made in harmony with the natural lines of tension in the skin. The skin’s natural lines were originally described by a German doctor named Langer. Surgeons call the preferred lines of healing “Langer’s lines,” and they try to use those lines for incisions.

You can see from these pictures that there is no Langer’s line that runs vertically down the front of the thigh. The incision for anterior hip replacement surgery is hard to heal because it does not run in one of Langer’s lines.

If the front of the thigh is a bad place for an incision, why do orthopedic surgeons make it there for minimally invasive hip replacement surgery? Because they must be able to access the femur bone, ball, and socket of the hip to replace it. The hip socket is part of the pelvis. If you put your hand on your “hip” and point your finger toward your groin your index finger is over the socket of your hip joint. Surgeons have tons of experience making incisions in that area: know anyone who had a hernia repair? An incision going from high to low in the groin area is a perfect Langer’s line. So, it’s not surprising incisions in this area heal beautifully, and without complication.

The trouble with making a groin incision for hip replacement surgery is the angle of the socket. In the classic approach for anterior hip replacement surgery, the orthopedic surgeon dislocates the ball of the hip from the socket, then prepares the cup for the implant. By making an incision over the socket the surgeon is unable to get the correct angle to prepare the cup. While the groin is a great place for the skin incision, it does not give the surgeon the right access to the cup to do the job right.

Dr. Matt Seidel, MD, and his colleagues have developed a solution. He developed a variation of the technique for anterior hip replacement surgery that is done through a groin incision on a Langer’s line and provides the right angle to properly prepare the cup. He did it by making a small second incision down on the thigh. The surgeon then passes the necessary instruments to prepare the cup through that opening. The size of the second incision turns out to be very small and doesn’t bother the patient’s much as it heals.

As it turns out, there are other advantages of Dr. Seidel’s technique for anterior hip replacement. Today many hip replacement surgeons believe that it’s better to avoid dislocation of the hip during surgery. This is the basis of the PATH approach to minimally invasive hip replacement surgery. Dr. Seide’s technique combines PATH with the anterior approach. As if that were not enough, the groin incision also naturally protects the nerves that run near the hip, making it even less likely they would be injured or even stretched during the minimally invasive hip replacement surgery.

Here at HRI we’re excited. We believe that hip replacement surgery should be done by an orthopedic surgeon with extensive experience in minimally invasive approach in an ambulatory surgery center the potential complications. The groin incision not only looks better in a bikini, it is likely to reduce the risk of nerve injury and may make dislocation even more unlikely. For anyone who needs hip replacement surgery that’s just a win, win, win.