One total knee replacement is not equal to the other. This surgery is complex and specialised and it is important to understand who and what is being done to you.
It surprises me how little some patients ask regarding something so important as surgery on your body. Many would scrutinise the details of their new car being ordered or who was doing building work on their home.
Here is an important checklist you NEED to ask any time you are thinking or are offered surgery:
- Who is doing the surgery.
- Studies have shown the more a surgeon does of one procedure the better their outcomes. Also the more specialised they are the more of their practice is focused on that particular procedure. Working in a University hospital or tertiary referral centre where the regions most difficult cases get directed means those surgeons know how and have the resources to deal with any complication or problem that may occur. There is now a national focus on GIRFT – Getting It Right First Time. Surgery done well by the most appropriate person possible in the most appropriate place. With surgery moving at such a fast pace, it is difficult to be a ‘jack of all trades’. Choose your surgeon carefully. Make sure they are keeping up to date with new advances and that their surgical choices for you are evidence based.
- What implant are they using and why?
- Not all implants are the same. In the UK a national joint registry (http://www.njrcentre.org.uk/njrcentre/default.aspx) is kept of all the joint replacements and partial resurfacings implanted and how they are functioning and if they have been revised. The 2 top implanted total knee replacements are the Depuy J&J PFC and the Zimmer Nexgen TKR. These are well tried and tested implants with many years of follow up. Newer implants are available but their data is limited. Using newer implants without long term data always has some risk attached and should be made clear to patients prior to surgery. Make sure you ask?
- Where is the Surgery going to take place?
- Where the surgery takes place is vitally important. Every hospital has different resources and backup. If anything were to become more complicated does the hospital or surgeon have a plan B? Do they carry out complex revision surgery and have those implants available on the shelf just in case. Small units will often only have the basic first time knee replacements on hand, leaving the surgeon stranded if there was to be a problem. Also if there was a medical problem do they have the ability to treat you in a higher care setting such as ITU. Some small private hospitals and district generals do not have these resources on hand and would have to transfer your care to a central teaching hospital often many miles away. We always hope and anticipate things will go smoothly but planning for the problems makes things safer in the long term. Just make sure you find out what their plan B is in the event of problems?
If you need more info or advice don’t hesitate to contact us: