How to choose the right orthopaedic surgeon

It’s not surprising that many of us are in awe of surgeons. We might also assume there’s little difference between them once we've established that they perform the surgery required. Mostly, choosing an orthopaedic surgeon isn’t about success or failure, but rather, lots of smaller benefits.

However, these ‘gains’ can be so significant - resulting in: faster recoveries, lower initial and long term pain levels, improvements in limb function and greater quality of life gains. Who wouldn’t want those?

Yet, start searching for surgeons on consultant finders or private hospital websites and you’ll find lists of consultants with biographies full of medical language and even longer lists of the procedures they perform, alongside peer and patient reviews. So how do we know what a surgeon is really good at?

Whilst a private hospital can have the latest proven technology, modern standards and highly trained specialist staff, ultimately the surgeon you select is one of the most important decisions that can affect your treatment.

Compare my Care asked some of the UK’s most experienced orthopaedic surgeons, and this was their advice for choosing a great surgeon.

1 Sub-specialism

Surgeons achieving the best outcomes for their patients, tend to sub-specialise in that specific procedure. For example, not just a specialist in knees (and no other area of orthopaedics) but also a ‘super-specialist’ in knee replacement surgery. Sub-specialisation suggests deep experience in a specific surgery or condition and tends to correlate with better surgical outcomes such as faster recoveries, minimised post-operative pain, better long term function and improved quality of life.

Before selecting a surgeon understand their sub-specialisation and their experience with handling your particular condition. You want a true specialist, with a relatively narrow focus, not a jack of all trades.

Would you ever consider asking a surgeon how many (specific) operations they have performed and what success rates they achieve… with data to back up their claims? A good or great surgeon would never be offended by this.

2 Performing high volumes of a procedure

Intrinsically linked to sub-specialisation (above), there is a clear correlation between higher volume surgeons (of a procedure) and better outcomes - having honed their technique over thousands of similar cases and surgeries.

Performing a procedure at high volumes also means experience in dealing with any unexpected complications during surgery. For hip, knee and other joint replacements, this can be accessed on the Surgeon Profiles section of the National Joint Registry website or through Compare my Care as we use every available piece of data to help you choose well.

3 Failure rate and complications

Patients should consider and ask for a surgeon’s revision rate. Revisions refer to surgeries that have failed or require correcting for any number of reasons, both short and longer term. If the revision rate exceeds the expected range, it suggests a higher number of unsuccessful surgeries being performed by a consultant. Please note, some procedures (such as partial knee replacement) have higher failure rates, so this can be a nuanced conversation.

The exception to the revision rate rule (found on the National Joint Registry) is for surgeons performing high volumes of revision operations of other surgeons’ primary procedures. These ‘super-specialist’ surgeons have the additional skills and experience in undertaking the more complex procedure that revision surgery is. Which is, of course, why considering a surgeon's revision rate is so critical for choosing well in the first place.

4 Patient Reported Outcome Measures (PROMS)

Surgeons and hospitals usually collect PROMS (Patient Reported Outcome Measures) from their patients to measure the change in pain levels, functionality, speed of recovery and improvements in quality of life. These measures are usually taken before surgery and then at various milestones after surgery: but often 6 months (procedure dependent) and are useful in determining whether a surgeon is delivering better overall outcomes.

5 Specific requirements and specialty

Of course every patient’s condition and presentation is unique and choosing a surgeon who might operate more often on a specific cohort of patients is important. Surgeons can have particular expertise in treating any of the following: specifically older or younger patients, those with a family history, elite sports vs general population, as well as particular comorbidities (other medical conditions such as diabetes). We can help patients find surgeons with a track record of handling special requirements and conditions or the potential complications associated with them.

6 Surgeons’ approaches and techniques

Some surgeons tend to specialise in a particular aspect of a procedure, perhaps favoring a technique or prosthetic. For example, total or partial knee replacements, custom made vs non-custom joints. Whilst no one procedure or treatment plan is the solution to all conditions, understanding the type of surgery you might need is useful and can be crucial when selecting a surgeon.

Qualities of a high performing surgeon:

• Has the experience to diagnose and treat complex conditions
• Uses their careful judgement regarding treatment options
• Better detects, avoids or manages any complications during surgery
• Understands a patient’s needs but judiciously manage expectations
• Uses a less invasive surgical technique without damaging muscle and tissue
• Helps patients recover faster from surgery with rapid recovery programmes
• Minimises the risk of revision or requirement for further treatment
• Informs their patients of all the risks and benefits, making them feel comfortable
• Has the self confidence to refer to another surgeon if better suited to the condition

Finding the best surgeon for you: checklist

Sub-specialising, high volume surgeons can improve the chances of a superior surgical outcome. Key factors to consider when selecting the right surgeon for you are:

Sub-specialism: You’re not searching for an orthopaedic surgeon performing multiple sub-specialties e.g. hip, knee and shoulder surgeries but rather a master of one area - two at most. Even more specialised would be a 'predominantly soft tissue specialist' or a 'high volume joint replacement surgeon’.

Volume/experience: has your surgeon conducted a high volume of this procedure?

Revision rates: does your surgeon have a lower revision rate than average?

Procedure outcomes: is your surgeon achieving better results for the patients they treat? Do they capture Patient Reported Outcome Measures (PROMS) and would they recommend their surgeon to others?

Specific requirements and specialty: is your surgeon an expert in treating patients who share your specific needs, such as comorbidities (eg diabetes), age and injury type and expectations e.g. return to high level sports?

Contact our team on 020 8064 0875 for more insight into surgeons and their super-specialisms.