Research suggests the ideal surgeon performs at least 150 hip replacements per year, is roughly 45–55 years old, and has completed a fellowship in joint replacement. While there’s no site where you can look up a surgeon’s total annual volume, you can find how many Medicare-covered hip replacements they performed in the past 12 months and extrapolate.
I’m not a medical professional, and I'm not offering medical advice. You should consult with a physician or other qualified medical professional for diagnosis, treatment, and advice. The content on this site is for informational purposes only.
Not everyone has the luxury of choosing their surgeon. In countries with national health care, patients are often assigned surgeons. Even in the US, choices are often restricted by location and insurance. Beyond that, availability may be an issue: the surgeon I ultimately chose was booked six months out just for an initial consultation.
But if you do have a choice between surgeons, here are some things to think about.
Let’s start with perhaps the most important evidence-based criteria.
*Note: throughout this post, I will use “THA” to mean total hip arthroplasty, the standard acronym for a total hip replacement.
Not surprisingly, studies have shown that there’s a learning curve to performing hip replacements. But are there thresholds where large risk reductions occur?
A study tracking a single surgeon’s first 500 direct-anterior THAs found major complication rates decreased from 5% to 2% and periprosthetic fracture rates from 9% to 2% — with dramatic reductions occurring after the first 100 cases.
Similarly, a study analyzing over 15,000 direct-anterior THAs found that revision risk stabilized after approximately 100 cases, with additional experience associated with only modest further improvement.
Beyond thresholds for initial mastery, studies have found thresholds for reducing risks and improving outcomes based on the annual number of THAs performed by a surgeon.
For instance, one study found that 35 per year reduced dislocations and revisions. Another found that 50 per year reduced intraoperative femur fractures. For the direct anterior approach specifically, a study found that 30 per year reduced fractures, dislocations, infections, and revisions.
But a 2025 retrospective study of nearly 300,000 surgeons over a decade found that those performing 150 or more THAs per year had lower infection rates and cumulative revision rates over the first two years post‑op.
Finally, a 2023 study from researchers at the Cleveland Clinic suggests that hip surgeons target 260 THAs per year to maximize the reduction of complications.
Thus, 150–260 THAs per year became a criterion in my search for a surgeon.
The authors of that last study wrote:
A persistent question is why patients continue to choose low volume surgeons, despite a known relationship between volume and complications. One explanation is that patients are not aware of their surgeons’ volumes because they are not readily available.
Indeed, there is no database that tracks all surgeries in the US, let alone one with public access.
However, Medicare’s “Care Compare” website provides the number of Medicare-covered hip replacements for individual surgeons, and we can extrapolate from there.
Go to the site, enter the surgeon’s location and name, then click their name in the results.
Once you’re on the surgeon’s page, scroll to Services > Procedures and click Procedures. You’ll see a page showing the number of procedures performed in the past 12 months, along with a percentile rank. For my surgeon, the stats were 90 hip replacements (97th percentile) and 146 knee replacements (97th percentile).
Since these are only Medicare tallies, they undercount total volume: most surgeons operate on non-Medicare patients as well. Is there a reasonable multiplier we can apply to estimate total volume?
Let’s start with the surprising fact that about half of all primary total hip replacements in the US are on patients younger than 65, who are typically not eligible for Medicare.
Two sources support that claim.
First, a CDC report states that from 2000–2010 about 94% of inpatient THAs were in adults aged 45 or older. Let’s be conservative and say it’s 96%. The same report indicates that 46% of those 96% were in the 45 to under-65 age range. Doing the math, that means about 48% of all inpatient THAs were in patients under-65. (See Figure 2 and the fourth paragraph under “Data source and methods.”)
Second, the 2024 annual report of the American Joint Replacement Registry shows a roughly bell-shaped distribution for primary total hip replacements, with a mean patient age of 65.6. Thus, it’s reasonable to assume that about half of THA patients are under 65. (See Figure 2.2.)
Therefore, on average, only half of a surgeon’s THA patients are on Medicare. So doubling a surgeon’s THA Medicare count is a good first approximation of a surgeon’s total THA volume.
But averages don’t apply to all surgeons. In an area with lots of retirees, a surgeon might operate almost exclusively on Medicare patients, and thus no multiplier would be needed. In contrast, surgeons at a university hospital might have only 25% of patients on Medicare, in which case their Medicare counts would need to be multiplied by 4.
My surgeon said he performs about 250 THAs per year. Recall that his Medicare count was 90. Thus, 2.5 would be a reasonable multiplier in his case.
To find a multiplier, first estimate the percentage of a surgeon’s patients who are on Medicare. Then divide 1 by that percentage. For example, if you estimate 67% of a surgeon’s patients are on Medicare, divide 1 by 0.67, which yields 1.5. In that case, multiply the surgeon’s Medicare count by 1.5.
Or you could just set a hard limit on the Medicare count. Obviously, a surgeon who performs 150 Medicare-covered THAs has met the 150 threshold. But dropping to 100 or 90 as a hard line is probably fine as well. (Again, my surgeon only had 90 Medicare THAs in the previous year, but he actually performs around 250 total.)
Upshot: even though Medicare counts don't tell the whole story, they can still be useful for filtering surgeons.
According to an article by the American College of Surgeons, the US has no mandatory retirement age for doctors, and over 40% will be 65 years or older within the next decade. In my own search, I encountered several prominent and highly regarded surgeons still practicing in their early seventies.
That same article indicates that research on older surgeons and patient outcomes is mixed. For instance, a review of 62 studies linked “increased age with decreasing medical knowledge, lower adherence to evidence-based standards of care, and worse patient outcomes.” Yikes. In contrast, a 2020 study of more than a million patients treated by more than 3,000 surgeons found that a 10-year increase in surgeon age was associated with a 5% decrease in odds of adverse outcomes and that surgeons over 65 had a 7% decrease. The article also summarized an analysis of 900,000 Medicare patients that found modestly lower mortality in operations performed by surgeons over 60.
For THAs in particular, research shows an interplay between age and volume.
A 2021 study of over 122,000 THAs and nearly 300 surgeons found that middle-aged surgeons (45–55) had lower complication rates than both younger and older peers. However, after excluding low-volume surgeons (< 35 THAs per year), older surgeons had similar complication rates to those who were middle-aged. Thus, in older surgeons, volume seems to matter more than age.
A 2025 study of THAs at top-ranked orthopedic hospitals found higher complication rates among surgeons ≤ 42 years old and also among those performing ≤ 100 THAs annually. No significant associations were found between complication rates and surgeon sex, geographic region, completion of fellowship, medical degree type, or residency reputation.
Putting it all together, I decided I wanted a surgeon in the 45–55 range, but would consider an older surgeon still performing more than 150 THAs per year. Ultimately, I also considered three surgeons on the younger side (39, 40, and 42), because they were recommended. All three were chiefs at major orthopedic hospitals and exceeded the 150 annual threshold.
While you want a surgeon who performs a high number of hip replacements each year, you probably don’t want one who does a high number each day.
The staff of one high-volume surgeon in Los Angeles told me that he performs 10–12 THA surgeries per day. I found that really surprising, since he explicitly states that he performs the entire operation up to closing and uses the direct anterior approach.
A 2019 study reported an average operating time of 93 minutes, and a 2020 study reported a median of 87 minutes. Maybe THAs have become more efficient and faster in recent years, but even if he were only spending 45 minutes per patient with a 15-minute transition, that would still be 10–12 hours of surgical work per operating day.
Add to that a 2024 study showing that surgeons experience significantly higher physiological stress and strain when using the direct anterior approach compared to a posterior approach for primary THA.
Every other surgeon I spoke with reported doing between 2 and 6 replacements per day. My surgeon said he does 5 to 6. On the day of my surgery, he did three hips, then two knees. I was his third hip.
Does it matter whether you’re the first, second, or sixth surgery of the day?
A 2025 study of nearly 8,000 surgeries across 44 surgeons in a variety of specialties found that the first case of the day experienced worse outcomes, although the authors cautioned that might be because many surgeons choose to start with the most complicated and challenging cases.
In contrast, a smaller 2015 study of THAs found no difference in various technical measurements like cup abduction and anteversion angles between surgeons’ first and second cases of the day.
A 2023 study found that in both total hip and total knee replacements, later surgeries were slightly longer than the first surgery of the day.
A 2018 study found higher risk of joint-specific (but not systemic) complications for the fourth and later surgeries of the day.
Maybe that suggests that if you have a choice, you should choose to be second or third? Personally, I’d rank this pretty far down the list of worries, and certainly not a basis for choosing a surgeon. More like something you might further research and try to optimize when scheduling your surgery, if you care.
In my case, I was asked by my surgeon’s scheduler if I wanted to be first, but she was just asking if I would have a problem arriving at 5 AM. I took the slot without thinking about research or “warm-up effect.” I just figured it was best to be first because my surgeon would be fresh, there’d be a lower chance of delay, and I’d get back home earlier. Ultimately, I was rescheduled to be his third surgery. I have no idea why, and it’s not something I worry about.
While a 2025 study I cited earlier in the section on surgeon age found no significant associations between fellowship completion and lower complication rates, several other studies have found better outcomes from surgeons who have completed a joint replacement fellowship.
A 2020 study found that THA patients had significantly shorter surgical times and hospital stays and required fewer opioids when their procedures were performed by fellowship-trained surgeons rather than non–fellowship-trained surgeons.
A 2025 study of more than 350,000 hip replacements over a decade found that procedures performed by surgeons who completed a fellowship in arthroplasty (adult reconstruction) had lower rates of infection, fracture, dislocation, and revision than those performed by surgeons without such training. The differences were found at 90 days, one year, and two years.
A separate 2025 study revealed that fellowship-trained surgeons performing THAs had lower complication rates, including dislocations, than non–fellowship-trained surgeons, even though they operated on patients with higher comorbidity burdens.
Such fellowships go by different names. Here are examples that cover most of the variations:
I haven’t seen evidence that prestige or competitiveness of the fellowship program affects outcomes, but I suppose it might make sense to give additional weight to top-tier programs. A bit of Googling will reveal different ranking lists if you’re interested.
I’ve seen a few surgeons who, in addition to the key fellowship in reconstruction or joint replacement, completed a second fellowship in sports medicine, oncology, or trauma. I don’t see how a second fellowship could be a bad thing.
Finally, I also considered board certification a minimum qualification. It’s highly likely that any surgeon meeting the volume, age, and fellowship criteria will be board certified, but it wouldn’t hurt to confirm.