THE BEST KNEE REPLACEMENT SURGEONS

Chosen by fellow doctors

WHAT are the hallmarks of a good doctor? Technical expertise and skill, of course — but someone who understands you, someone you trust, is also vital.

Indeed, research shows that a good relationship with your doctor can improve the chances of a successful outcome. But how do you find a specialist who fits the bill?

That’s where this unique series of guides, running every day this week in the Mail, can help.

We’ve identified the country’s top consultants — as judged by their peers. We’ve canvassed the views of more than 260 consultants across seven specialties from around the country, and asked them this very simple, but key, question: If your own nearest and dearest were to need treatment in your field, to whom would you refer them — and why?

The consultants who earned the most votes from their peers are the ones who made it into our guides — though patients should bear in mind that this is not a scientific study.

And, of course, there are many superb and highly skilled specialists all over the country who didn’t make it on to our list, but who spend every day transforming patients’ lives.

To help you make informed decisions about your care, we’ve also talked to experts about the latest thinking on treatment. Today, we focus on knee replacement surgery . . .

IT CAN MAKE SENSE TO DELAY SURGERY

KNEE replacement surgery is the most common type of joint replacement operation in the UK, and the number of patients having the procedure is rising.

The average age for getting a new knee is 69, but what worries some experts is that the percentage of younger people going under the knife for this major procedure is on the rise.

Almost 110,000 knee replacements were carried out on the NHS and privately in the UK (excluding Scotland) in 2016 — 30 per cent more than in 2010.

And osteoarthritis — wear and tear of the joint that causes pain and deformity — is the reason for virtually all cases.

obesity is partly blamed for the boost in demand from younger patients; a joint overloaded with excess weight will wear out faster.

But another factor is that ‘the current generation of people aged 40-65 are less tolerant of putting up with a painful knee,’ says richard Spencer Jones, a knee replacement surgeon at The robert Jones and Agnes Hunt orthopaedic Hospital in Shropshire.

He is not suggesting that we should be more robust about pain, rather that he fears the fallout from people swapping their own rickety knee for a replacement too soon, as ‘ some of these people will live well into their 90s and that knee is likely to need replacing a couple more times — [these will be] increasingly challenging procedures with more risks and potential complications’. In fact, 20 per cent of knee replacement patients are not happy with the result and 5 per cent feel worse off after, says Philip Mitchell, an orthopaedic surgeon at St george’s Hospital and the Fortius Clinic, both in London.

‘unfortunately, if you do an MRI of the painful knee of someone in their 60s, you will definitely find some arthritis.

‘What it won’t show is the degree of pain, or if replacing that knee will make it better. Yet armed with this MRI, the patient will almost certainly find a surgeon prepared to operate.’

All orthopaedic surgeons tend to agree that the timing of a procedure is critical in achieving the best result for patients.

operate too soon and patients with a stiff and occasionally painful knee are unlikely to be happy with the replacement.

Delay too long and you risk making patients miserable, housebound and potentially suffering more muscle-wasting and deformity — resulting in more complicated surgery and a more challenging rehabilitation.

There are concerns that the increasingly long waits too many NHS patients face for surgery may have implications for this.

At the knee unit at The royal Devon and exeter Hospital, surgeons will often first try using conservative measures with borderline patients before they undertake surgery.

‘Think of this as a pre-emptive strike,’ says Professor Andrew Toms, an orthopaedic surgeon at the hospital. ‘Typically, this will be a mix of exercise, physiotherapy, weight loss and painkillers with the objective of trying to reduce patients’ pain and improve knee function sufficiently to avoid or stall knee replacement surgery.

‘If after going through this, patients don’t feel they have improved, then I will operate,’ says Professor Toms.

Knee replacement falls into two main categories: partial knee replacement, where just one compartment of the arthritic knee is replaced; and total knee replacement, the choice for patients with widespread

arthritis, where two or three compartments are replaced. The advantage of partial replacement is that it is a smaller operation which preserves the ligaments, so the chances are it will feel more like a normal knee; with total knee replacement one or both of the main (cruciate) ligaments are sacrificed. But one of the drawbacks is that surgeons who do few of them get worse results than with a total knee replacement (see box overleaf).

After surgery, patients have to brace themselves for hard work to regain full function in their new knee. But patients still struggling with pain six months or so later should have no qualms about returning to their consultant to be investigated, says Andrew Porteous, a knee surgeon at Southmead Hospital in Bristol.

‘This could be caused by infection or because the knee was done badly — some surgeons try to fob patients off because they are worried a number of re-dos will flag a problem with the data they have to submit to the National Joint Registry [which publishes outcomes for every orthopaedic surgeon and hospital unit]. So they will do X-rays and say, “These don’t look too bad, off you go.”

‘In instances like that, the patient should go back to their GP and ask for a referral to a regional centre.’

So how do you avoid the pitfalls and pinpoint the very best knee replacement surgeon? The best are highvolume surgeons, who do a large number of operations, and are expert in both partial and total replacements, so you get the full range of options. Patients can check their prospective surgeon’s profile on the National Joint Registry website to see how their surgeon’s caseload measures up against the average (see right).

To identify the country’s very best knee replacement surgeons, we canvassed the views of almost 40 leading consultants from around the country. Here, we reveal their choices, with a selection of personal comments about why they chose them.