Choosing a surgeon is an important part of planning a knee replacement. For many patients, the decision is not simply about whether to have surgery, but also about what type of surgery may be appropriate, where to have it and which surgeon to trust with the procedure.
It is therefore reasonable to spend time researching your options before making a decision.
How much do patients research their knee replacement?
Research suggests that the internet is already an important source of information for people considering knee replacement.
In a study of 200 patients undergoing total knee replacement, 70% of patients or their relatives had searched online for information about knee replacement before surgery. In the same study, 46% of patients or relatives had searched online for information about the surgeon, and 15% said that information found online influenced their choice of surgeon.
The study was conducted outside the UK and involved patients treated by a single surgeon, so these figures should not be assumed to represent all UK patients. Nevertheless, they demonstrate that online research can form part of the process by which patients and their families make decisions about knee replacement.
There is also evidence that patients may not always have access to the information they would like when researching individual surgeons.
A UK study examined the websites of 200 orthopaedic surgeons and found that most provided basic information such as professional qualifications and areas of specialist interest. However, around half did not provide information about areas such as teaching, research or patient satisfaction, while very little information was available about outcomes such as mortality and morbidity.
The study concluded that the information available online was not always sufficient to allow patients to make a fully informed choice about an individual consultant.
References:
- The influence of the internet on the patients’ choice of surgeon for their total knee replacement surgery. Journal of Clinical Orthopaedics and Trauma. 2021;17:186–190.
- Can patients really make an informed choice? An evaluation of the availability of online information about consultant surgeons in the United Kingdom. BMJ Open. 2012;2:e001203.
What should you look for when choosing a surgeon?
A surgeon’s reputation is important, but there is no single factor that should determine your choice.
Instead, try to build up a picture of the surgeon’s experience, expertise, approach to treatment and the care you can expect before and after surgery.
1. Does the surgeon specialise in knee surgery?
Knee replacement is a specialist area of orthopaedic surgery. It is reasonable to ask how much of the surgeon’s practice is devoted to knee surgery and how frequently they perform knee replacements.
You may also want to understand whether they regularly perform the particular procedure you are considering.
2. Do they offer the type of operation you may need?
There are different types of knee replacement, including:
- total knee replacement
- partial or unicompartmental knee replacement
- revision knee replacement
- robotic-assisted procedures
However, the availability of a particular technique should not be confused with it being the right treatment for you.
The appropriate operation depends on factors such as the condition and distribution of arthritis, your symptoms, examination findings, imaging, age, activity levels and individual circumstances.
A good surgeon should be able to explain why they recommend a particular approach and discuss reasonable alternatives where they exist.
3. Ask about alternatives
Knee replacement is not automatically the right answer for everyone with knee arthritis.
Before proceeding, you should have an opportunity to discuss whether surgery is appropriate, what alternatives are available and what might happen if you decide not to have surgery.
This is consistent with NICE guidance, which recommends shared decision making for people being considered for joint replacement. NICE says that discussions should include alternatives to joint replacement, the potential benefits and risks of available procedures and implant types, and the possibility of needing further surgery.
Reference: NICE guideline NG157, Joint replacement (primary): hip, knee and shoulder.
4. Understand the surgeon’s experience
There is no single number of operations that automatically makes someone the “right” surgeon.
However, useful questions include:
- How frequently do you perform knee replacements?
- What proportion of your practice is knee surgery?
- How long have you been performing knee replacement surgery?
- Do you regularly perform the procedure being recommended?
- What are your arrangements for follow-up?
- How are complications managed?
You should feel comfortable asking these questions during your consultation.
5. Consider the hospital as well as the surgeon
The surgeon is only one part of your treatment.
Consider:
- where the operation will take place;
- what facilities are available;
- arrangements for physiotherapy and rehabilitation;
- how complications are managed;
- who provides your follow-up care;
- what happens if you need further treatment.
For private treatment, you should also establish exactly what your quoted price includes.
Don’t choose a surgeon simply because they offer a particular technique
Terms such as robotic knee replacement, computer-assisted surgery and particular implant brands can sound compelling when researching online.
But the newest or most technologically advanced option is not necessarily the best option for every patient.
Your surgeon should be able to explain:
- why a particular procedure is being recommended;
- what evidence supports it;
- whether there are alternatives;
- what the potential benefits and disadvantages are;
- and whether it is appropriate for your particular knee.
NICE emphasises that information should be specific to the procedure being considered, understandable to the patient and provided from the first appointment and throughout care.
Prepare for your consultation
One of the best ways to assess a surgeon is to have a proper discussion with them.
Consider taking a written list of questions to your consultation.
For example:
Why do you recommend knee replacement for me?
Which type of knee replacement would you recommend and why?
Would a partial knee replacement be suitable for me?
What alternatives do I have?
How frequently do you perform this operation?
What are the important risks in my particular circumstances?
Where would my surgery take place?
What happens if I develop a complication?
What follow-up and rehabilitation will I receive?
What exactly is included in the private treatment price?
You don’t need to choose a surgeon during your first consultation. If you are unsure, it can be reasonable to take some time to consider the information you’ve been given or seek another opinion.
The aim is an informed decision
There isn’t necessarily one “best” knee replacement surgeon for everyone.
The right choice depends on your circumstances, your clinical needs and your preferences.
NICE recommends shared decision making because patients should understand the available options, their potential benefits and risks, and how those options relate to their individual circumstances.
Good online information can help you prepare for that conversation, but it shouldn’t replace an assessment and discussion with a qualified orthopaedic surgeon.
The aim of researching beforehand isn’t to diagnose yourself or decide which operation you must have. It is to arrive at your consultation better informed and better prepared to ask the right questions.