Choosing a surgeon for a hip or knee replacement is a major decision.
Most patients know to look at a surgeon’s training, board certification, experience, hospital affiliation, and perhaps online reviews. Those are all reasonable things to consider.
But there is one question that almost nobody tells patients to ask:
What are your patients’ actual outcomes?
Not just whether the X-rays look good. Not just whether complications are rare.
Do patients actually have less pain? Better function? Better mobility? And are they meaningfully better one year after surgery?
That is where patient-reported outcomes become incredibly important.
The problem: patients still do not have a universal surgeon scorecard
In an ideal system, every patient considering joint replacement would have access to a simple national scorecard.
You would be able to look up a surgeon and see:
- How many hip or knee replacements they perform
- Their training and board-certification status
- Their complication and revision rates
- How their results compare after accounting for patient complexity
- How much their patients improve in pain and function
- How many patients achieve a clinically meaningful improvement
We are not there yet.
The American Joint Replacement Registry is an enormous national resource and now contains data from more than 5 million hip and knee replacement procedures. Participating institutions can use registry data for benchmarking and quality improvement. But that is different from having a universal, easy-to-use, patient-facing scorecard for every individual joint replacement surgeon in the country. AAOS
Until that exists, surgeons and health systems may need to voluntarily make these results available through their websites, patient education materials, or directly during a consultation.
I think we should.
What are patient-reported outcomes?
Patient-reported outcome measures, often called PROMs, are standardized questionnaires that measure outcomes directly from the patient’s perspective.
For hip replacement, one commonly used measure is the HOOS Jr.
For knee replacement, one commonly used measure is the KOOS Jr.
These questionnaires evaluate things such as pain and physical function before surgery and again afterward.
That matters because an X-ray can look perfect while the patient still hurts.
A surgeon may see an implant that appears perfectly positioned, but the patient may still struggle to walk, climb stairs, sleep comfortably, or return to the activities they care about.
PROMs help answer the question that ultimately matters:
Did the operation actually make the patient better?
National AJRR data illustrate how useful this can be. In the 2025 AJRR Annual Report, 93.3% of patients with linked preoperative and one-year postoperative HOOS Jr. scores after primary hip arthroplasty achieved a meaningful improvement by the report’s defined threshold. AAOS
Medicare is already moving in this direction
This idea is not theoretical.
CMS has established a hospital-level patient-reported outcome performance measure for elective primary hip and knee replacement.
The measure evaluates improvement in patient-reported pain and physical function after surgery and incorporates clinical and claims-based information for risk adjustment. CMS says the risk-standardized improvement results will begin public reporting in 2027 as the measure moves into mandatory reporting. CMS Data
Importantly, this is currently a hospital-level measure for a defined Medicare population, not a universal surgeon-level report card.
That distinction matters.
We are increasingly collecting these data, but patients still cannot simply search every surgeon in America and see a standardized, risk-adjusted individual outcome report.
I think that should eventually change.
Five questions to ask your joint replacement surgeon
1. How many of these operations do you perform every year?
Do not just ask whether your surgeon performs “a lot” of joint replacements.
Ask for the number.
“How many total knee replacements did you perform last year?”
“How many total hip replacements?”
If your case is unusual, be even more specific:
“How many patients like me do you treat?”
A surgeon who performs a large number of routine primary joint replacements may have very different experience from someone who routinely manages revisions, previous fractures, major deformity, infection, or complex reconstruction.
Volume alone does not prove quality, but experience is an important part of the picture.
2. What is your training?
Ask whether your surgeon is board certified and what kind of training they completed.
For a surgeon whose practice focuses heavily on hip and knee replacement, fellowship training in adult reconstruction is another useful piece of information.
It is also reasonable to consider the institution.
Joint replacement is not performed by one person alone. It involves the surgeon, anesthesia team, nurses, operating-room personnel, physical therapists, sterile processing, and postoperative care team.
A high-volume joint replacement center develops systems around these operations.
3. What are your complication and revision rates?
Patients should feel comfortable asking about complications.
That may include infection, dislocation, fracture, blood clots, readmission, stiffness requiring another procedure, and reoperation.
It is also reasonable to ask about revision surgery — how often a hip or knee replacement ultimately requires another operation.
But raw numbers can be misleading.
Imagine two surgeons.
One primarily operates on healthy patients with straightforward arthritis.
The other accepts severe deformities, previous infections, multiple prior operations, periprosthetic fractures, and difficult revisions.
It would not be fair to compare their raw complication rates without considering the difference in patient populations.
That is why risk adjustment matters.
CMS already uses risk-standardized approaches for several hip and knee replacement quality measures, including complications and patient-reported improvement. Centers for Medicare & Medicaid Services
Why “cherry-picking” matters
Poorly designed public reporting can create unintended incentives.
If surgeons are judged exclusively on raw complication rates or raw outcome scores, they may be rewarded for operating mainly on younger, healthier, lower-risk patients.
That is sometimes referred to as cherry-picking.
Meanwhile, surgeons who accept complicated revisions, high-risk patients, or patients with multiple previous operations may appear to have worse numbers simply because their cases are harder.
A useful national reporting system therefore needs appropriate risk adjustment.
The goal should not be to find the surgeon with the prettiest raw number.
The goal should be to determine whether a surgeon is performing at or above an appropriate benchmark given the patients they treat.
4. Do you track patient-reported outcomes — and can I see them?
This may be the single most important question patients are not being told to ask.
Complication rates are extremely important, but major complications fortunately occur in a relatively small percentage of patients.
What happened to everyone else?
Did their pain improve?
Can they walk farther?
Can they climb stairs?
Can they travel?
Can they get back to golf, hiking, exercise, work, or playing with their grandchildren?
PROMs give us a way to measure that.
As surgeons and health systems increasingly collect preoperative and approximately one-year postoperative outcomes, these results should become easier for surgeons to access through dashboards and benchmarking tools.
And if surgeons have those data, I believe patients should be able to see them too.
I publish my own patient-reported outcomes directly on the front page of MatthewSloanMD.com.
If I am going to encourage transparency, I think I should be willing to show my own numbers.
What if your surgeon will not show you their outcomes?
This requires some nuance.
Not every surgeon currently has access to a sophisticated surgeon-specific, risk-adjusted PROM dashboard.
Some health systems have better data infrastructure than others, and much of today’s public reporting still occurs at the hospital rather than individual-surgeon level.
So a surgeon saying, “Our system does not provide individual risk-adjusted results yet,” is different from a surgeon refusing to discuss outcomes altogether.
But if the data exist and your surgeon is unwilling to show or discuss them, I think it is fair to wonder why.
Transparency does not mean pretending every patient has a perfect result.
No surgeon can promise that.
The point is to measure performance honestly, compare it with meaningful benchmarks, learn from the data, and continually improve.
5. What percentage of your patients would choose to have the surgery again?
Not every practice tracks this question, but I think it is an excellent measure.
Knowing everything they know after surgery — the pain, rehabilitation, recovery time, inconvenience, and risks — would patients make the same decision again?
Ultimately, that is one of the most patient-centered definitions of success.
What should a national joint replacement scorecard look like?
I would like to see a future where every patient considering hip or knee replacement receives a standardized, understandable report containing:
- Surgeon volume
- Board certification and training
- Hospital or surgery-center volume
- Major complication rates
- Revision rates
- Patient-reported improvement
- Percentage achieving a meaningful clinical improvement
- Patient satisfaction or willingness to undergo surgery again
- Risk-adjusted comparison with an appropriate national benchmark
That would be far more informative than relying primarily on advertising, reputation, or Google reviews.
The infrastructure to collect much of this information increasingly exists. The next step is making it understandable and accessible to patients.
Because transparency should not simply mean that the data exist somewhere.
Transparency means patients can actually see them.
The bottom line
If you are choosing a hip or knee replacement surgeon, surgeon volume, training, board certification, and experience at a high-volume joint replacement center all matter.
Complication rates and revision rates matter too.
But the question almost nobody tells you to ask is:
“What are your patient-reported outcomes, and can I see them?”
A technically perfect operation is important.
But ultimately the outcome that matters most is whether patients actually feel and function better afterward.
And if we are asking patients to trust us with their hip or knee, I believe they deserve to know how our patients actually do.
You can view my patient-reported outcomes on the front page of MatthewSloanMD.com.
Watch or listen to Episode 57 of The Joint Replacement Podcast: “How Do You Know If Your Joint Replacement Surgeon Is Any Good?”
About Dr. Matthew Sloan
Dr. Matthew Sloan is a board-certified, fellowship-trained hip and knee replacement surgeon specializing in primary and revision joint replacement, robotic-assisted surgery, and complex hip and knee reconstruction.
Medical disclaimer: This article is for educational purposes only and is not a substitute for personalized medical advice. Individual treatment decisions should be made with your healthcare professional.