The best knee replacement surgeons — as 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.

KNEE REPLACEMENT SURGEONS RATED BY THEIR PEERS PROFESSOR ANDREW TOMS

Royal Devon & Exeter Hospital

WHAT THEY SAY ABOUT HIM: ‘A leader in knee replacement. When he was drafted into the Royal Devon, it was renowned for hip replacement. He has now put the hospital on the map for knees in the same way,’ says one of his peers. ‘He is honest and thorough and discusses the risks and benefits of surgery with his patients.’

‘Andrew has made it his life’s work to eradicate every painful knee in the country,’ adds another. ‘He takes on very complex and challenging cases and sorts them out.’ PRIVATE: Nuffield Health Exeter Hospital.

ANDREW PORTEOUS

Southmead Hospital in Bristol

WHAT THEY SAY ABOUT HIM: ‘He is measured, hard-working, considerate and highly skilled in all aspects of knee replacement,’ one of his peers reveals.

‘He tailors his surgery to the needs of his patients and is a firm advocate of partial knee replacement where appropriate — his view is that a lot more knee replacement patients could benefit from partial knees.’ PRIVATE: Spire Bristol Hospital, Nuffield Health Bristol Hospital.

PETER JAMES

Nottingham City Hospital WHAT THEY SAY ABOUT

HIM: ‘Quietly spoken, gentle and with a beautiful pair of hands — in other words he is technically gifted. When you see him operate, he makes everything look so easy. He does a lot of revision [when the implant has failed and has to be replaced] and complex work,’ says one surgeon.

‘He did my dad’s knees and is undoubtedly the most experienced and able knee surgeon in the country,’ says another. PRIVATE: BMI The Park Hospital in Nottingham.

RICHARD SPENCER JONES

The Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry WHAT THEY SAY ABOUT

HIM: ‘Highly knowledgeable, he is excellent technically and renowned for his revision surgery. At this top level everyone is dexterous, but he manages to stay cool even with the most challenging cases,’ says one. ‘He gets very good results and is the sort of person you’d want to operate on you,’ reveals another of his peers.

PRIVATE: The Robert Jones & Agnes Hunt Orthopaedic Hospital (private care), Nuffield Health Shrewsbury Hospital.

DAVID BEVERLAND

Musgrave Park Hospital in Belfast WHAT THEY SAY ABOUT

HIM: ‘A quietly spoken, gentle man who has the most phenomenal work capacity and who does no private work. He was brought in to clear the waiting lists in orthopaedics in Northern Ireland and has made it his life’s work, but unfortunately this has faltered in recent years due to further demand and no additional funding to pay for it,’ comments one.

‘A dedicated and very good surgeon.’ PRIVATE: Mr Beverland does not work privately.

PROFESSOR LEE JEYS

The Royal Orthopaedic Hospital in Birmingham WHAT THEY SAY ABOUT HIM: ‘He does lots of complex revision knee replacements [where the implant fails and has to be replaced] where he deals with infection, bone loss and rebuilding bones and ligaments,’ according to one of his peers.

‘A lovely chap with a great pair of hands who also does primary [firsttime] knee replacement, but he has carved out a niche for himself with challenging revisions.’ PRIVATE: BMI The Priory and Edgbaston Hospitals.

RICHARD CARRINGTON

Royal National Orthopaedic Hospital in Stanmore in London WHAT THEY SAY ABOUT HIM: ‘Loads of experience and he does everything from primaries, in other words the first knee replacement, to revisions, when implants re-done,’ says a f

‘He’s very stra feels knee repla for you, he will lots of unneces says another. PRIVATE: Royal N Hospital (priva Hospital, both in Hospital in Watfo

well-deserved and his patients are fond of him.’ PRIVATE: Nuffield Health The Manor Hospital in Oxford. ALSO HIGHLY THOUGHT OF:

CHRISTOPHER DODD

Nuffield Orthopaedic Centre in Oxford WHAT THEY SAY ABOUT

HIM: ‘Excellent dedicated knee surgeon who is a specialist in partial knee replacements.’ PRIVATE: Nuffield Health The Manor Hospital in Oxford.

MICHAEL RISEBURY

Basingstoke and North Hampshire Hospital WHAT THEY SAY ABOUT

HIM: One of his peers describes him as ‘an excellent surgeon, recognised as an expert in early interventions such as osteotomy.’ This is where either the top of the shinbone or the bottom of the thighbone are cut and shaped to realign the knee and ease pain. ‘He believes you can sometimes hold off replacing the knee for a while with this.’ PRIVATE: BMI The Hampshire Clinic.

JONATHON LAVELLE

Chelsea and Westminster Hospital in London WHAT THEY SAY ABOUT

HIM: ‘Very empathetic, level-headed and what we in medicine refer to as a good pair of hands. He would not operate unless he felt it absolutely necessary,’ according to one of his peers. PRIVATE: Bupa Cromwell Hospital, The Lister Hospital, Fortius Clinic, all in London.

DAVID HOULIHANBURNE

Hillingdon Hospital in West London WHAT THEY SAY ABOUT

HIM: ‘Gifted technically and down to earth, he gets on well with his patients and is a great communicator.’ PRIVATE: Bupa Cromwell Hospital, Fortius Clinic, both in London, BMI The Chiltern Hospital in Buckinghamshire, BMI Bishops Wood Hospital in Middlesex.

TIM WILTON

Royal Derby Hospital WHAT THEY SAY ABOUT

HIM: ‘Old-fashioned in the best sense, sensible and meticulous. He’s not interested in fads. He does things because they work and have been shown to work over a long period of time,’ reveals one surgeon. ‘He is a thinker, who pays great attention to detail. He does knees awesomely once, so they last a jolly long time.’ PRIVATE: Nuffield Health Derby Hospital.

PAUL GIBB

Tunbridge Wells Hospital in Kent WHAT THEY SAY ABOUT

HIM: ‘A lovely man and excellent technically, very good with patients, he is very thorough and pays great attention to detail,’ says one. PRIVATE: Nuffield Health Tunbridge Wells Hospital, The Horder Centre in Crowborough.

TIM SPALDING

University Hospital Coventry WHAT THEY SAY ABOUT

HIM: ‘He was my choice for both my father’s knees,’ one of his peers reveals. ‘A senior surgeon who pays great attention to detail and is very self-driven and organised.’ PRIVATE: Nuffield Health Warwickshire Hospital, Fortius Clinic in London, Spire Little Aston Hospital in Birmingham.

PHILIP CHAPMANSHEATH

Southampton General Hospital WHAT THEY SAY ABOUT

HIM: ‘Technically a really excellent surgeon who does both partial and total knee replacements and primary [first] knee replacement and lots of revision surgery [where the implant fails and has to be replaced]. Also a very nice guy.’ PRIVATE: Spire Southampton Hospital, Nuffield Health Wessex Hospital.