In today’s joint replacement market, surgery is rarely the first decision patients make.
The first decision is who to trust.
Martin Jenter, DO, a hip and knee reconstruction surgeon who operates at Henry Ford Providence Novi (Mich.) Hospital and Michigan Outpatient Surgical Solutions, where he also serves as medical director, sees that shift every day.
Patients arrive prepared, not just with imaging and questions, but with comparisons already in mind. Many have seen two or three surgeons before him. Some are still undecided about surgery itself; others are deciding which version of the story they believe.
“They’re basically shopping,” Dr. Jenter said. “I’m the third person they’ve seen. They’re trying to figure out whose answer they like the best.”
For surgeons, that shift has quietly reshaped the work. Clinical judgment still matters, but it is no longer enough. Today’s consultations require time, patience and a level of emotional labor that was not part of the job a decade ago.
“I personally have to spend much more time with the patient,” he said. “There are many more questions, why is it indicated, why now, why not wait.”
And even after a long explanation, the answer is often no.
“You go through a huge explanation,” he said. “Then you ask if they’re ready to schedule, and they say, ‘Thanks, but no thanks.’”
Reputation is the currency patients trust
In a competitive market, Dr. Jenter does not pretend that surgical skill alone determines where patients land. Most orthopedic surgeons, he tells patients, are comparably trained. “We’re all very equally skilled,” he said. “I’m not going to tell you I’m the only one who can do a hip or knee.”
What patients care about, he said, is outcome, and how those outcomes are described by people they trust.
“If you know someone who had something done by me and they had favorable results, that’s all you should care about,” he said. “If you hear bad things about people, lots of complications, poor results, you don’t want to go there.”
Often, what tips the decision is not technique, but attention.
“Some people tell me, ‘You’re the first person who actually listened to me,’” Dr. Jenter said. “You’re the first person who put their hands on me.”
That dynamic, he said, has made consultations far more time-consuming than they once were.
“You’re almost having to romance these people,” he said. “Get them to fall in love with you, even knowing that shouldn’t be your priority.”
The pressure is not just professional. It is reputational. In an era of online reviews and instant feedback, dismissing a patient who wants reassurance carries risk.
“If you blow them off, you’re liable to get a bad Google review,” he said. “I’m totally reliant on a reputation that I’ve created for the 27 years I have been in practice.”
Access shapes trust as much as care
Where surgery happens matters, too. Dr. Jenter operates both in a hospital setting and at a privately owned ASC he has helped build and lead since 2018. For many patients, having access to a surgery center is no longer optional.
“A lot of people won’t pick you if you don’t have a surgery center,” he said. “You really need surgery center access.”
That expectation has intensified as same-day discharge has become routine for hip and knee replacements. For some patients, especially older ones, the shift runs directly against what they believe recovery should look like.
Many patients, he said, still expect to go to rehab and assume therapy will be slow, anticipating a longer hospital stay than is now typical. “We have to train them mentally that they’re going to go home pretty quickly,” he said.
At his hospital, nearly all patients go home within 24 hours. At his surgery center, discharge is always same-day. Rehab facilities, he said, are rarely part of the plan. “I think I have about a 1% discharge to rehab,” he said.
But outpatient surgery requires far more preparation in the clinic. Unlike hospitals, surgery centers do not offer joint classes or standardized education.
“There’s no such thing as a joint class,” he said. “So I have to do a lot of the prep work myself.”
Technology raises expectations — and confusion
As patients arrive more informed, they also arrive with assumptions about technology.
Robotics. Navigation. Biologics. The promise, often implied, is better surgery and faster recovery. “There’s a lot of fake information,” Dr. Jenter said.
Robotic-assisted surgery, he said, is a useful tool, but not a guarantee. “It doesn’t make your surgery pain-free or make you recover faster like the marketers say,” he said.
Still, patients ask for it. Some will leave if it is not available. “If you don’t offer a robot, you’re always fighting that stream of patients,” he said.
Other innovations, such as anterior hip replacement, have proven more durable in his practice. He adopted the approach in 2013 and saw demand grow organically as patients shared their experiences.
Stem cells and PRP, by contrast, have required careful boundary-setting.
“It will not solve your arthritic problem,” he said. “It’s not even indicated in severe arthritis.”
Many patients pursue those options anyway, often returning months or years later when expectations collide with reality.
“They come back and say it didn’t work like I thought it would,” he said.
Satisfaction is not a promise — it’s a trajectory
For Dr. Jenter, patient satisfaction is not about perfection. It is about predictability. “I want them to see me at two weeks and tell me their pain was well controlled,” he said. “They’re doing well with therapy. They’re happy they had it done.”
By six weeks, most are back to work or sport. “They all want to know when they can get back to golf or pickleball,” he said. After nearly 30 years in practice, he is comfortable setting those expectations, and meeting them.
“I know what my outcomes are,” he said. “I know how to make that happen.”
What has changed is not the surgery. It is the context around it.
Patients arrive with more information, more options and higher expectations than ever before. For surgeons, success now depends as much on communication and credibility as it does on technical skill.
The operation may take an hour. Earning trust takes far longer.
