Choosing a Surgeon for Total Knee Replacement

Orthopedic surgeons perform total knee replacement surgery. Doctors must go through years of special training to become board-certified orthopedic surgeons, but there is no special certification or licensing specific to knee replacement surgery.

A patient may increase the likelihood of a successful total knee replacement surgery (total knee arthroplasty) and decrease the likelihood of complications by choosing a surgeon and a hospital that have dedicated resources and perform a high volume of knee replacements each year. ¹ Hervey SL, Purves HR, Guller U, Toth AP, Vail TP, Pietrobon R. Provider Volume of Total Knee Arthroplasties and Patient Outcomes in the HCUP-Nationwide Inpatient Sample. J Bone Joint Surg Am. 2003 Sep;85-A(9):1775-83. PubMed PMID: 12954837. ^{, 2} Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am. 2004 Sep;86-A(9):1909-16. PubMed PMID: 15342752. ^{, 3} Wei MH, Lin YL, Shi HY, Chiu HC. Effects of provider patient volume and comorbidity on clinical and economic outcomes for total knee arthroplasty: a population-based study. J Arthroplasty. 2010 Sep;25(6):906-12.e1. Epub 2010 Jan 29. PubMed PMID: 20116204.

Learn about the surgical procedure and recovery timeline for
Total Knee Replacement

More Surgical Experience Is Associated with Fewer Complications

The National Institute of Arthritis and Musculoskeletal and Skin Diseases ⁴ "Experience is Key for Total Knee Replacement Outcomes." National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov. Published 2005. Accessed September 4, 2012. cites a study that found complication rates to be inversely related to the number of total knee replacement procedures a surgeon or hospital performs each year. The study used data from more than 80,000 Medicare beneficiaries who underwent total knee replacement surgery and found:

• Surgeons who performed fewer than 12 knee replacements each year had an average medical complication rate of 4.0%, compared to 2.9% for surgeons who performed at least 50 knee replacements each year. ⁵ Katz et al. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am. 2004 Sep;86-A(9):1909-16. PubMed PMID: 15342752.
• Hospitals that did fewer than 25 knee replacements each year had an average medical complication rate of 4.6%, compared to 3.0% for hospitals that did at least 200 knee replacements each year. ⁶ Katz et al. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am. 2004 Sep;86-A(9):1909-16. PubMed PMID: 15342752.

Medical complications included post-surgical pneumonia, pulmonary embolism, heart attack, deep infection or death within the first three months after surgery. Other complications, such as the loosening of a prosthetic component in the knee, were not included in this study.

Factors that did not seem to affect complication rates in this study included:

• The number of years since the surgeons graduated medical school
• Whether the surgeries were performed in private or public hospitals, teaching or non-teaching hospitals, or urban or rural hospitals

Of course, the complication rates stated above are averages from one study. It is possible for a “lower volume” hospital or surgeon to have relatively low complication rates. A patient is entitled to ask about the complication rates specific to a particular surgeon or hospital.

Learn about how doctors such as Orthopedic Surgeons treat arthritis in Arthritis Treatment Specialists

What to Expect After Knee Replacement Surgery

Ninety percent of the knee replacement surgeries performed each year are considered successful, meaning that the patient’s pain is decreased and function is improved.

However, studies show overall patient satisfaction with the surgery to be slightly less, at about 85%. ⁷ NIH Consensus Development Conference on Total Knee Replacement. National Institutes of Health. http://consensus.nih.gov. Accessed December 28, 2011. Some of that difference might be attributed to patients whose expectations for surgery were too high or who did not anticipate the hard work and time necessary for rehabilitation. ⁸ Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010 Jan;468(1):57-63. PubMed PMID: 19844772; PubMed Central PMCID: PMC2795819. ^{, 9} Hepinstall MS, Rutledge JR, Bornstein LJ, Mazumdar M, Westrich GH. Factors that impact expectations before total knee arthroplasty. J Arthroplasty. 2011 Sep;26(6):870-6. Epub 2010 Nov 12. PubMed PMID: 21074356. ^{, 10} Alina Tugend, "What Did You Expect? It Makes a Difference." The New York Times, January 13, 2012. Therefore, a patient and surgeon should have a frank conversation about:

• Possible short- and long-term outcomes and complications
• Postoperative pain management options
• The time and effort needed for post-surgical rehabilitation
• How the new knee will feel, and what the patient will and will not be able to do with the new knee

See What to Expect After Knee Replacement

An orthopedic surgeon should be able to explain all of these issues and answer a patient’s questions.

Getting a Second Opinion for Knee Replacement Surgery

A patient is entitled to get a second opinion or even a third opinion from another doctor. For example, a prospective knee replacement patient may want to try to find another orthopedic surgeon with lower complication rates or who better addresses the patient’s concerns. Patients should keep in mind that the second opinion may or may not be more accurate than the original opinion.

Getting a second opinion or switching surgeons is not unusual, and patients should not worry about hurting a doctor’s feelings.