Recommend an orthopedic surgeon for a 60-year-old patient with diabetes, hypertension, and heart disease needing hip replacement surgery?

I Cannot Recommend a Specific Surgeon or Clinic

I cannot provide recommendations for specific surgeons or clinics, as this falls outside the scope of evidence-based medical guidance. Surgeon and facility selection is a personal decision that should be based on local availability, credentials, patient preferences, and institutional quality metrics rather than clinical practice guidelines.

What I Can Provide: Evidence-Based Preoperative Optimization Guidance

For your 60-year-old patient with diabetes, hypertension, and heart disease requiring hip replacement, the focus should be on preoperative optimization to reduce morbidity and mortality, which is far more impactful than surgeon selection alone.

Critical Preoperative Optimization Requirements

Before proceeding with surgery, this patient requires optimization of multiple risk factors to minimize adverse events and maximize outcomes 1:

Diabetes Control

• Target HbA1c <7.5% before elective hip replacement 1
• Patients with poorly controlled diabetes (HbA1c >8.5%) face increased risk of postoperative complications including infection, wound healing problems, and cardiovascular events 1
• Implement hospital-specific perioperative glucose protocols and screen for diabetic complications (nephropathy, neuropathy, retinopathy) 2

Cardiovascular Assessment

• Continue antihypertensive medications through the morning of surgery - there is no evidence that withholding ACE inhibitors or other antihypertensives improves outcomes 3, 2
• Document active cardiac conditions, significant arrhythmias, severe valvular disease, and assess functional capacity (ability to climb stairs or walk at 4 mph = ≥4 METs) 2
• Optimize beta-blockers and heart failure medications preoperatively if applicable 2

Weight Optimization

• Elevated BMI increases adverse events and results in lower patient-reported outcome scores after total hip arthroplasty 1
• While guidelines acknowledge this risk, any achievable weight reduction preoperatively is beneficial 1

Essential Preoperative Workup

Order these investigations immediately 3:

• Full blood count (40% of patients are anemic preoperatively) 3
• Comprehensive metabolic panel including renal function (40% have renal dysfunction) 3
• Blood glucose and HbA1c 3, 2
• ECG 3, 2
• Chest radiograph only if clinically indicated 3

Medication Management Pitfalls to Avoid

Do NOT withhold the following medications perioperatively 3, 2:

• Continue ACE inhibitors/ARBs through surgery 3, 2
• Continue beta-blockers (abrupt discontinuation increases risk) 2
• Continue statins 2

Critical medication review 3:

• 20% of patients over 70 take >5 medications, and 80% of adverse drug reactions are potentially avoidable 3
• Review for inappropriate dosing and potential drug interactions 3

Anesthetic Planning

Regional anesthesia (spinal) is preferred for patients with diabetes, hypertension, and heart disease 1, 3:

• Reduces sympathetic hyperactivity 3
• May improve outcomes in diabetic patients with comorbidities 3
• Allows early mobilization and better postoperative pain control 3
• Either spinal or general anesthesia is appropriate based on patient factors and anesthesiologist judgment 1

Interdisciplinary Care Model

Interdisciplinary care should be provided to decrease complications and improve outcomes (strong recommendation) 1:

• Involvement of orthopedic surgeon, hospitalist/internist, anesthesiologist, and nursing staff 1
• Preoperative medical clearance by internist or hospitalist familiar with orthopedic surgery 1, 3

Intraoperative Considerations

Tranexamic acid (TXA) should be administered to reduce blood loss and transfusion need (strong recommendation) 1

Cemented femoral stem is recommended for older patients or those with poor bone quality (strong recommendation) 1

How to Select a Surgeon

While I cannot recommend specific individuals, consider these factors:

• Board certification in orthopedic surgery with fellowship training in adult reconstruction/arthroplasty
• High-volume surgeon (>50 hip replacements annually) at a high-volume center
• Access to interdisciplinary orthogeriatric care team 1
• Institutional quality metrics including infection rates, readmission rates, and patient-reported outcomes
• Patient preference regarding wait times versus specific surgeon choice 4

The most important factor for this high-risk patient is ensuring the surgical facility has robust perioperative medical management protocols and interdisciplinary care capabilities 1, 3, 2, which will have greater impact on outcomes than individual surgeon selection alone.