THE QUESTIONS TO ASK YOUR SURGEON BEFORE YOU SIGN UP

How often do you operate?

‘PATIENTS shouldn’t be afraid of asking their surgeon about the number of knee replacements they carry out,’ says Professor Phil Turner, a knee surgeon at the NHS Stepping Hill Hospital in Stockport and vice-president of the British Orthopaedic Association. ‘The key is accuracy putting the implant in and, in general, the more operations a surgeon does, the better they will be at it. If a surgeon is doing fewer than 20 a year, that’s not a good sign and patients should think about going elsewhere. Most specialist knee replacement surgeons will be doing a least 150 a year.’

How many knee ops have you had to re-do?

ASK your surgeon about his or her revision rate (where a failed implant needs replacing). You can also check The National Joint Registry, which has information on over two million joint replacement operations in England, Wales and Northern Ireland since 2002. This includes more than 2,000 individual surgeons’ results and how they compare with the national average. It also provides data on the number of knee replacements, revisions and mortality rates by hospital. If yours has a higher-than-expected revision rate, ask why. Rather than a red flag, it could mean they’re specialists in salvaging knees when surgery has gone wrong (and such surgeons are very well-placed to avoid such mistakes themselves). See njrsurgeonhospitalprofile.org.uk and njrcentre.org.uk

Should I try anything else before I go under the knife?

AN ARTIFICIAL knee will never be as good as your own — most patients rate them about three-quarters as good, according to the charity Arthritis Research UK. Plus, surgery carries a risk of infection, bleeding and the implant failing, so if you don’t need it, you don’t want it. There are options to try before surgery, ask your surgeon if you are suitable. ‘If you wait too long, the knee gets stiffer and more deformed,’ says Professor Turner, ‘and results of surgery are worse if knees are really bad to start with.’ Steroid injections can ease inflammation and pain, while physiotherapy strengthens the thigh muscles that support the joint. Orthotics (insoles to correct knee alignment and gait) or an ‘off-loading’ knee brace (which applies pressure to the unaffected side of the knee) may have ‘some benefit’, he adds. But in most cases, these only delay surgery by six months to a year.

Are there other surgery options for me?

ARTHROSCOPY — keyhole surgery to clear debris in the knee — used to be common for osteoarthritis, but is now rapidly in decline as NICE has said it doesn’t help. A recent review of 25 studies in The BMJ concluded that the procedure offers no ‘important benefits’, as it neither reduces pain nor improves function and mobility, and carries risks of pain, swelling and difficulty putting weight on the leg. But osteotomy — where bone is added or removed from a damaged joint to shift the weight away from the damaged area — can ‘buy’ most patients ten or 15 years before having a knee replacement. Professor Adrian Wilson, a knee specialist at The Wellington Hospital in London, says osteotomy is the ‘operation of choice’ for people who want to stay active. ‘Wherever possible we advise joint preservation procedures such as osteotomy,’ he says.