What are my options?
There are differences in knee replacement designs and providers
Like all common and familiar product categories, there are different makes and designs of knee implant and there are differences in how well they work. Success can also depend on the quality of service provided and how experienced a surgeon is in using a particular product.
Although the cost of an implant is relatively small compared to the cost of surgery, state funded and private healthcare systems usually select implants based on financial and logistical concerns and implants available from large companies that can offer bundled deals and supply. Even surgeons have less say in what implants they use than in the past. This makes it quite reasonable to believe that the best implant for you – the one that is most likely to give you what you want – might not be the one offered to you by the first surgeon or hospital that you are sent to.
You have the right to choose
If you are diagnosed with knee arthritis and recommended to have knee replacement surgery, it is important to understand that you have the right to choose your implant, surgeon and hospital – regardless of how your treatment is funded. The implant is going to be yours for what should be a long time, so making good decisions early is important.
How to choose
You are more likely than your surgeon or hospital to make the decision based on how well other patients have returned to normal life, how satisfied they are with their knee replacement and how long the device is proven to last. So the first thing to decide is what implant you want; then find the best surgeon or hospital to get it fitted. This does mean doing some research, but with the availability and easy access to good information it can be quite straightforward.
Many countries now have a National Register of joint replacements. Independent organisations also provide ratings for implants based on the quality and amount of clinical evidence for their performance. These sources usually provide information on how many patients require further treatment in the years after surgery – a fundamental but important measure of performance. National Registers may also report on the performance of individual hospitals or surgeons and may show how experienced they are and how often they perform hip or knee surgery.
Journal articles are often available on the internet free of charge and can provide comparative information including measures for pain, function and activity based on studying groups of patients. Even when journal articles need to be purchased, synopses (abstracts) are usually available for free and results of studies may be referred to in other articles.
Information on manufacturer’s websites can also be evaluated for factual versus marketing content. Do the marketing claims make sense to you? Do they provide evidence? How well do they relate to what you think is important?
Forums, blogs, YouTube videos and social media posts also include feedback from other patients who have received knee replacement surgery.
Don’t be put off by the wealth of information available. We discuss how to navigate these sources of information and what they mean on this website in ‘How Success is Measured’.
What to do next
Once you have decided on your knee implant, you can request to be treated by a knee surgeon of your choice. Most surgeons only operate at one or two hospitals – many work for the NHS or local state-funded hospital and also have a private practice. When deciding, look at the success rate of the surgeon and the hospital. After all, it is not just about the surgery – aftercare, such as physiotherapy, provided by the hospital is critical in the overall success of the procedure. It’s best to select a specialist who has good experience with your choice of knee implant. An example of how to do this in the UK is to visit the NJR Surgeon and Hospital profile website: http://www.njrsurgeonhospitalprofile.org.uk.