TKR Knee surgeon recommendation?

[Jeronimo]

Hi all,

First off thank you for all your posts and information on this forums! I have slowly been reading my way through. I am looking for a good knee surgeon for diagnostic reasons around London, UK. I tore my ACL/PCL/MCL and meniscus (180 degree knee dislocation) 25 years ago. I've had multiple-surgeries since then in the US. About seven years ago the meniscus in the inner part of the knee was gone and there is bone on bone ridging. I was suggested 3 different courses of actions:

a.) Get a full TKR
b.) A unicompartmental
c.) Osteotomy

There was basically a big debate between three different knee surgeons about TKR vs Unicompartment vs Osteotomy. Because I was quite young, active, fit, and there was a lot of trauma to my knee it really wasn't clear which course of action was optimal. In the end one surgeon who I've known for a long time recommended I wait it out for a TKR as the technology was only getting better. Two others both wanted to do Unicompartmentals. My original surgeon was recommending osteotomy and bracing.

Fast-forward to now, the tibia has moved further in and is noticeable in my gate, and I would really like to be able to enjoy more activity as I am in my late 30s and have a very athletic 8-year-old daughter I'd like to somewhat keep up with.

Thanks for the advise.

 

[Jaycey]

@Jeronimo Welcome to BoneSmart!

I am looking for a good knee surgeon for diagnostic reasons around London

I can highly recommend Phillip Mitchell. He is based at St George's Hospital in Central London or (better yet) South West London Elective Orthopaedic Centre (SWLEOC). I had my RTHR at SWLEOC. Great place as they only do orthopaedic surgery there.

Are you in the position to see a surgeon privately and then get on his NHS list? That's the route I took with both THRs. You get more time to discuss your situation and ask questions. Wait times these days are pretty dire!

 

[Jeronimo]

I have fully private insurance. I can use whoever I want in whichever country I want. So if there is anyone in Europe or US you recommend shoot. I have to say it's a complicated surgery, it isn't your average knee. So ideally I'm looking for someone who deals with NFL Players, Moto GP Riders, etc. because it's a surgery on a 3 times operated knee. I have a dead guy's ACL in there, my PCL was Grade 2 last time, and no meniscus on the inside position, so bone on bone ridging. Also my tibia is and fibia are inverting inwards.

The list of surgeon's I've had were all great both for surgery and diagnostic. What's hard for me is that they all had different views on what I should do. Now it's 10-years-later and the advise followed was ok. One of the issues I had was a couple of the surgeons wanted to use me as a guinnea pig as I was in good athletic shape, but also quite young (late 20s then), for Unicompartmental/Robotic knee surgery. It might have worked well. Might not have. The original surgeon and another surgeon my father used who we've known for years both advised this was really experimental for me and chances were I'd need to keep replacing unicompartmental knee every few years and the literature at the time showed it didn't work well for someone with as much injury as I had. Part of the argument was the tech would only get better and don't take the risk of rejection for a TKR/annesthesia risk etc.

I think the first step now is go get MRI'd, X-Rayed, and go get 1st opinion.

 

[Jaycey]

Well I stand by my recommendation for Mitchell. But if you want to travel (and no, travel to Europe or the US is not needed) then Prof Peter Kay is at the top of the list. He has private practice as well as NHS in Wrightington Hospital (the premier Orthopaedic Centre in the UK). Wrightington was where joint replacement started.

You don't want a sport doc - you want an extremely experienced knee guy. That's Peter Kay.

Any surgeon you see will want an x-ray and either CT or MRI depending on your situation. I would wait and let them specify the diagnostics.

 

[Jeronimo]

Thank you! I'll go see them both. Why do you say no to a sports guy? I'm talking about someone who has done a lot of knee trauma in younger patients, age range 20s to early 40s.

Trust me because I've been through this it's a hard one. Lots of different opinions from different people. Everyone wants to operate their way! I have a house in the US (Bay Area & Denver) so it isn't hard to go see someone around there. I also don't mind hanging around for a few months lol. I've seen Dr. Stone there. One of my original surgeons was Dr. Thabbit (49ers). I've also seen Prof. Cobb in London, Prof Haddad was go to guy whom I've known for years. All are great. I'm still thinking of doing a unicompartmental with Cobb.

The 3d printed knees are very interesting now. But I need to learn a bit more.

 

[Jaycey]

Why do you say no to a sports guy?

Expertise needs to be complex orthopaedics, not sports medicine. Just because they are connected to a high profile team doesn't mean they are what you need.

I have a house in the US (Bay Area & Denver) so it isn't hard to go see someone around there.

I spent most of my life in the Bay Area. Why would you want to deal with a system that is SO expensive? I know you have insurance. But we are talking mega $$$$ if you want to get treatment there.

Ultimately the decision is yours. But you may be getting to the point where you have just too many choices. Start looking at relationships. Who can you partner with so that you both come away with success?

 

[Claire56]

I would be surprised if a sports orthopedic would do knee replacements at least in the US. That said, they might be a good source for a referral.

 

[Jeronimo]

Yes, I think you're the first relationship . I'm 100% with you on the relationships part. I've had two knee surgeries already and a foot one, so I'm not exactly "new". The doctors I was mentioning are who I saw about 10 years ago. There was a large number of choices then, and TKR's/Unicompartmentals were viewed very differently than they are now. I'll go see the two you recommended and take it from there, thanks a lot for the recommendations!

 

[Roy Gardiner]

I am looking for a good knee surgeon for diagnostic reasons around London, UK

Paul Allen who works at Harlow hospital in Essex and privately was highly recommended by my surgeon, the now sadly passed John Ireland. However, I defer to Jaycey in this matter and suggest Allen as your 2nd opinion.

FWIW I think you're taking exactly the correct line by wanting to be totally in charge. It is, after all, your knee.