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TKR Any experiences with TKR in the EU

Ian3266

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Hi all, I live in north west UK, and my left knee is shot. Its bone on bone and has been for some time.

I am a life long believer in and supporter of the NHS and having to pay for necessary treatment privately or do without is to me offensive. Healthcare should be based on peoples needs, not their ability to pay. I'm not against private treatment in principle but it should not be the only option.

Having said that I now find myself in the position of having to consider it. My experience with my knee to date has been an eye opener. Cursory research turns up phrases such as "Patient choice" and "The legal right to treatment within 18 weeks". What a load of nonsense, there are so many loopholes and ways around such concepts that they are reduced to being utterly meaningless.

I was referred to my surgeon in late 2018 who initially required me (with justification, BMI 32) to lose weight. My knee got progressively worse and in Aug 2019 after losing just over 3 stone he put me on the list for surgery. My 18 weeks had expired in mid December 2019 and having heard nothing I rang his secretary who informed me I was still a long way down the list. I enquired of her that as I had a legal right to treatment within 18 weeks what my options were. She actually chuckled and said "Oh I'm afraid that Mr xxxx has never managed to achieve an 18 week list" and that my options are to find another surgeon "Its called patient choice you know" and with that she put the phone down, which was just as well as I may have become rather rude had she not. That was 9 months ago and I still haven't heard anything. I am obviously aware of the Covid 19 complications but I had been on the list for 30 plus weeks before that kicked off.

Anyway rant over and done with I find now that if I want any sort of useful existence (I can no longer walk more than literally a few feet) I'm gonna have to put my hand in my pocket which fortunately I'm able to do. Research shows that private treatment in Poland, France etc is significantly cheaper than UK with savings of several 1000's of pounds so not be sniffed at.

Question, has anyone done this and what were your experiences. Of the actual visit to the country itself and the need for and availability of aftercare upon return to the UK.

Regards ian
 

Celle

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Hello @Ian3266 - and :welome:

I completely understand your frustration at having to wait so long for your surgery.
I live in New Zealand, where we have a health system very similar to the UK's NHS - chronically overworked and under-funded. I am on the waiting list to have a shoulder replacement.

The problem with the 18-week "legal right to treatment" is that it is an ideal. But with a limited number of available operating theatres and surgeons from other specialties also needing to use them, there are simply too many people who need surgery for that ideal to be achieved.

I would be very reluctant to go to Europe for joint replacement at the moment.
First, because of the Covid situation, and second because how would you be able to choose a surgeon skilled enough to do the excellent job you need?
Remember that their health services are under pressure as well.

Sara61 did have her knee replacement done in Portugal, and I'll ask her to come and speak to you - but she lives in Portugal, and has done so for some time.

It may be possible for your case to be pushed further up the waiting list if the condition of your knee has deteriorated noticeably. To do this, I believe, would require you to go to your GP and convince him/her that your knee has become much worse and your need for surgery has become more acute. Your GP would then write to the hospital and you should then have your knee re-assessed by your surgeon.

That's how it would work in NZ anyway. @Jaycey lives in England and I'll ask her if I'm right, or not.
 

Tykey

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Even with the best intentions, a lot of surgical staff have been coopted to covid treatment wards. So it's unlikely to improve any time soon.
I've always found that the only way to get up the list is to keep arguing our case, calmly and consistently. . Maybe look for other hospitals?
I think a secretary needs sacking!
Good luck
 
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Ian3266

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Hi Celle & Tykey, thanks for the replies. As you say Celle going to Europe for surgery with the current Covid situation doesnt seem too attractive a prospect. However my knee has become very bad now and like Tykey says there seems to be little prospect of a return to normality any time soon. I can't sleep, the farthest I can now walk is down the garden path to the car and that with great difficulty.

I'm not familiar with the health service in New Zealand but here in the UK each NHS area has it's own management team and budgets. They all have differing levels of problems and competency and manage their budgeting differently. The net result is that it's very much a post code lottery what level of health care you receive.

I have spoken with my GP and she assures me that while there is in theory this concept of Patient Choice in practice and especially with the Covid complications I would be unlikely to significantly improve my chances of an earlier resolution by looking for different hospitals/surgeons , indeed I could make it worse.

I understand and do accept all of the above. However my quality of life is now so reduced that I'm in a situation I never thought I would arrive at. I have no confidence that the NHS will provide me with treatment in any acceptable time scale, actually I'm already well beyond that.

I can afford to and do intend to pay privately for my treatment however galling that is. As prices in many European countries (even the more affluent ones) are substantially less than in the UK it's a no brainer really to consider the option.

So my question is still, has anybody done this and if so what were your experiences.

Regards ian
 

Celle

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I have spoken with my GP and she assures me that while there is in theory this concept of Patient Choice in practice and especially with the Covid complications I would be unlikely to significantly improve my chances of an earlier resolution by looking for different hospitals/surgeons , indeed I could make it worse.
I am not suggesting that you try different hospital areas, but that your GP contacts the hospital/surgeon whose waiting list your name is on, and states that, in her opinion, your knee condition has deteriorated greatly and your need for surgery is now more urgent. she could ask for your condition to be re-assessed.
I know that waiting list patients' surgery needs are classified as "Routine" or "Urgent". Being classified as "Urgent" could move your name higher up the list.
(I did work in the NHS prior to moving to NZ.)

I can afford to and do intend to pay privately for my treatment however galling that is. As prices in many European countries (even the more affluent ones) are substantially less than in the UK it's a no brainer really to consider the option.
It would be a no-brainer for me to not go to Europe at this time.
  1. Because of Covid, their surgeons will be under greater pressure and they may not be willing to undertake surgery on a non-citizen of their country - especially now, after Brexit.
  2. I think the travelling would increase your chances of catching Covid.
  3. There's no way you can assure yourself that you'd be getting a competent surgeon. While going to Europe may appear cheaper, you get what you pay for, and that might be a less competent surgeon.
  4. You would have no follow-up medial care, should a problem develop.
 

Sara61

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@Ian3266 I live in the Algarve Portugal, our health care system is very similar to the NHS however like the NHS the waiting list for any operation is quite long, I was on such a list for nearly 3 years and fortunately last year as my knee had, very badly deteriorated I was then put on the urgent list, as the hospital were unable to fit me in, I was then given the choice of several private hospitals to choose from at the expense of the local hospital, I opted for Gambelas HPA as it was the closest to where I lived, the surgeon came highly recommended by friends and so far I am very happy with the results.
Personally if you can afford to go privately I would suggest doing it in your own country, firstly you are close to home for any aftercare, secondly a few guarantees are offered whereby if you go to a foreign country, this might not be the case.
We do have several excellent private hospitals in the Algarve, Hospital Particular do Algarve (HPA) is an excellent group, many of the English Expats use them, but I think you would need to stay in the Algarve for several months after your operation to fully recover.
Although I am not sure of the full costs of a knee replacement I think it is in the region of 15000-20000€ plus your accommodation, tests etc etc.
I will add another lady whom has gone privately here maybe she can enlighten you further, @Izabel.
 
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Ian3266

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Thankyou all for your replies but my question was really aimed at people with direct experience of the course of action I am contemplating. I really do appreciate the replies but it seems to me that they are largely based on prejudice and misconceptions.

Of course I can't be sure of the surgeons competence, that also applies equally here. This is why I was hoping to ask for the experience of people who have actually done it.
 

Celle

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I don't think you're going to find anyone who has done what you are wanting to do.
I have been on BoneSmart for 8 years and I have been on staff for 6 years.

I do not recall anyone who has gone to Europe for surgery as you want to do.

We have had people who went to India and who had bad results, with no after-care follow-up.

I am a registered nurse and I have worked in hospitals in both the UK and NZ. I know that in both those countries it is possible to check a surgeon's experience and success rate. Have you investigated the possibility of doing the same for a European surgery?

I have had three knee replacements myself and I know how important after-care can be, particularly if you have an problems.

Believe me, we're not speaking from prejudice and misconceptions, but from experience.
 
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Ian3266

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Because of Covid, their surgeons will be under greater pressure and they may not be willing to undertake surgery on a non-citizen of their country - especially now, after Brexit.
We are talking private medicine here, wave euros at them and they'd happily operate on a Martian.
I think the travelling would increase your chances of catching Covid.
Yes that is a concern but given the irresponsible behaviour currently being exhibited here it's probably no worse than visiting Tesco and I have to balance it against my ever diminishing quality of life.
There's no way you can assure yourself that you'd be getting a competent surgeon. While going to Europe may appear cheaper, you get what you pay for, and that might be a less competent surgeon.
Is sticking with our NHS a quality assurance guarantee, I think not, indeed from direct experience I know not, theres good and bad everywhere. The cost of living in many EU countries is far less than the UK and so comparing price in different countries is not a reliable indicator of quality.
You would have no follow-up medial care, should a problem develop.
Now this is one of the issues I would certainly want to be sure of before going down this route. I have read several adverts claiming to provide UK based follow up in the event of problems, but does it work in practice. Which is why I was asking for experience from people who have been there and done it.
 

Jamie

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Ian, I don't think you're going to find anyone on our forum who has done what you are proposing. I've been with BoneSmart since 2008 and cannot recall a single member who has gone private in another country and then come back to the UK for aftercare. I personally wouldn't risk it if you can afford to have the surgery in the UK. You might save a little money, but you'll have only bad options if you do this and find you cannot get quality aftercare once you return home again. Do you really want to chance that?
 

Tykey

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Needs must, as the saying goes.
Are you sure European waiting lists are any shorter and surgery available in these strange times? Would brexit alter anything?
I would have no concern about the actual surgery in Europe, but looking at the practicalities getting home might be difficult for some weeks, it's a long trip. I wouldn't look at travelling home for 2 to 4 weeks, and then only over land and sea. Even then it would be a painful challenge.
But I might suggest you look at what the Care UK specialist hospitals can do for you at the moment. They do both NHS and private work, and are normally cheaper and normally much, much, quicker. However, like most hospitals their staff and facilities are supporting covid work at the moment.
The most appropriate one for you would probably be Barlborough, just down the road from me in Sheffield. They did a superb job on both my knees, and claim to be far cheaper than other hospitals.
You are between a rock and a hard place, I hope you manage to find somewhere comfier to land.
 

helenium

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the practicalities getting home might be difficult for some weeks, it's a long trip. I wouldn't look at travelling home for 2 to 4 weeks, and then only over land and sea. Even then it would be a painful challenge.
I was just about to say the same thing @Tykey. Well said.
 

Tykey

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If I could afford it, I'd hire a nurse and a local cottage for a few weeks, and call it a holiday!
 

Jaycey

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I really do appreciate the replies but it seems to me that they are largely based on prejudice and misconceptions.
My reply is not based on prejudice or misconception - just on first hand experience. I been working with the BOA (British Orthopaedic Association for our members outside the UK) Council for many years. I can confirm that areas are now being reconfigured to offer "elective" surgery again. The 18 week wait time is no more. But if you can get your GP issue an urgent referral, it will be addressed.

Another route that I have taken (with both hips) is to book a private appointment with my surgeon of choice and then have the surgery through the NHS. Unfortunately I didn't have the funds to self fund my surgeries. But if you get your GP to refer you privately for a consultation you will get into see a surgeon within days. Indeed if you want to self pay you may have your surgery scheduled very quickly as well.

Finally, if a member of my surgeon's staff spoke to me as that medical secretary did, I would not hesitate to find another surgeon. If you would like help in finding someone I am more than happy to do a bit of research for you. I would need your location and what hospitals are near you. Also the name of your current surgeon as we would want someone with no connections to him.
 
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Ian3266

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Ian, I don't think you're going to find anyone on our forum who has done what you are proposing. I've been with BoneSmart since 2008 and cannot recall a single member who has gone private in another country and then come back to the UK for aftercare.
I only came across Bonesmart by accident while looking for something else, I would have joined long ago had I known of it. A Google search for EU medical tourism turns up several adverts with testimonials from UK residents which admittedly may or may not be genuine, hence my questions, I was hoping maybe some of them were Bonesmart users. It would seem not, which may just mean they didn't know of it either. The apparent lack of users with relevant experience is unfortunate but doesnt mean it's never been done.
Are you sure European waiting lists are any shorter and surgery available in these strange times? Would brexit alter anything?
My questions are about EU based private healthcare, waiting lists and Brexit aren't factors.
But I might suggest you look at what the Care UK specialist hospitals can do for you at the moment. They do both NHS and private work, and are normally cheaper and normally much, much, quicker.
Care UK private prices while being on the cheaper side of UK private healthcare prices are still not cheap. 10k plus for a TKR, 6K and less is achievable in the EU. Funding private healthcare while possible for me will still be a stretch and that sort of difference is very significant for me.
However, like most hospitals their staff and facilities are supporting covid work at the moment.
Which does not equate to short waiting lists. I dont want to jump out of the frying pan into the fire
The most appropriate one for you would probably be Barlborough, just down the road from me in Sheffield.
I'm afraid Barlborough is nearly 90 miles from me. I'm near Blackburn, Lancashire.
 
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Ian3266

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Thankyou Jaycey for your reply. Having re-read my posts so far it appears to me that maybe I'm coming across as firstly

Flying the Flag for EU medical tourism. I can state absolutely that I'm not indeed the idea is somewhat frightening. I have however totally lost faith in the ability of the NHS to provide me with treatment while I'm still young enough to benefit from it. If private healthcare is the only option remaining then it can be found very much cheaper abroad. I was only trying tl see if anyone had actually done it and what their experiences of it were.

And secondly,

Somewhat belligerent. Well I must admit that this is sometimes a label that I do tend to attract. It was not and is not my intention to cause offence to anyone. If I have done so then I am indeed sorry for that.

I have no doubt that many here have considerable experience of both the condition and the health care industry. I was however asking if anyone had experience relevant to my specific questions, it would seem not unfortunately.

Finally, if a member of my surgeon's staff spoke to me as that medical secretary did, I would not hesitate to find another surgeon. If you would like help in finding someone I am more than happy to do a bit of research for you. I would need your location and what hospitals are near you. Also the name of your current surgeon as we would want someone with no connections to him.
I live near Blackburn, Lancashire, in the East Lancashire Hospitals NHS Trust area. My surgeon is Mr Iain Gordon Lowrie.

Honestly I dont really have a problem with him personally. His medical record seems as good as anyone elses and he is quite a pleasant person. As regards his secretary, well at the time I was really annoyed but in retrospect I worked all my life in a public service industry and know first hand how bloody annoying Joe public can be at times. It shouldn't happen but its human nature and sometimes it does.

I dont have a particular gripe with the surgeon or his staff or indeed the system. It is what it is and as we all know its buckling under the present situation. It just feels like it isnt and wont work for me.

I started work when I was 14 and had to finish last year at 66 primarily because of my knee, I would probably still be working otherwise. I just feel like a cripple now and can't see any light at the end of the tunnel.
 

Jaycey

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Well you are right on the door step of one of the UK's leading centre of excellence for orthopaedic surgery - Wrightington Hospital (assuming you don't mind driving just under 20 miles one way). They are a dedicated orthopaedics only hospital so no issues with mingling with covid patients. Infection rates at these centres for excellence are the lowest. I had my RTHR at one these centres and it was a very positive experience. Very well run and the staff only have ortho patients to worry about.

The choice of surgeons is endless. But the following surgeons all perform 100+ THRs per year, some focus on knee only:

George Pavlou
Jeremy Jarratt (Robotic assisted surgery)
Aslam Mohammed
Jeremy Oakley

All these surgeons have a private practice as well as NHS practices in multiple hospitals. So if you use the method I suggested you can book an appointment for a private consultation and then agree to get on their list for Wrightington. A private appointment will be much longer than an NHS clinic and will give you time to get a feel about whether this consultant is someone you can work with. You need to stress both to your GP (who will need to refer you) and to the consultant that you are at the stage where it is a quality of life issue. You might want to look at this thread Score chart: how bad is my arthritic hip/knee. Print off a scorecard and take it with you to any appointment. It will show both you and the consultant just how bad you are feeling.

The site that has all the surgeon data is the National Joint Registry. Just plug the surgeon's name in the top box and you will get all the information including hospitals where they work.

Just FYI - your current surgeon's numbers are fairly low. You want someone in the hundreds range.
 
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Ian3266

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Thanks for that Jaycey, food for thought and useful information. Definitely an approach I will pursue. As regards funding the actual procedure in the UK, that may well be a bit beyond my reach, well comfortable reach anyway, but thanks anyway.
 

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My two cents worth is you get what you pay for most of the time. Cheaper isn't always worth it and you could end up paying more in the long run.
 

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Ian, I want to be sure you caught Jaycey's recommendation about private UK service. It is possible to use a combination of private and NHS support for your surgery. You book a consultation appointment privately and, if you decide to have the surgery, that is done through the NHS system.

Many of our UK members have done this and it can speed the process up considerably because you usually get the private appointments without much wait. I would strongly suggest you at least give that consultation option with one or more of the surgeons Jaycey has suggested a try. I think you'll find a hospital that does a lot of these surgeries much more accommodating than the facility you've been working with.
 

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