Joint replacement — what patients don’t know
Bones and Joints Anyone preparing for joint replacement may not be aware that they can choose which implant and surgeon they get, and what difference it can make. It’s time to do some research.
As we age, degenerative arthritis can take a devastating toll on our bodies, and particularly our hips and knees. That's because articular cartilage, the low-friction lining in our joints, wears away over time. Unfortunately, unlike other tissue, cartilage doesn't have the ability to repair itself. “Once it's gone, it's gone,” says Michael Tuke, founder and chairman of Orthopaedic company, MatOrtho Ltd. “And as it wears out, the trouble — and pain — begins.”
Yet joint degeneration isn't only an issue for people in their 60s, 70s or 80s. It can happen to those in their 30s, 40s and 50s, too.
“We are all living longer and want to be more active, so this is a condition that will affect more and more of us,” says Tuke. “Joints can also be damaged by excessive physical activity or injury in earlier life. Whatever age you are, when joint cartilage wears away and bone begins rubbing on bone, it's extremely painful.” Deformity can also occur as the joint starts to collapse.
A life-changing operation
In the end, it may become so painful that even moving around becomes a problem. “This is severely limiting, of course, and can lead to all sorts of other health issues,” says Tuke. “We have to keep our bodies active. If we don't move much because of pain and prefer to sit in a chair all day, it can shorten our lives. That's the bottom line.”
Which is why joint replacement can be so life-enhancing for patients with degenerative arthritis. “It's not simply a way out of pain,” says Tuke. “Joint replacement can help us live longer especially by being active in later life.”
Yet there's something that people with the condition do not realise, says Tuke. When it comes to a hip or knee operation, we don't have to accept the first surgeon we are sent to and whatever implant they happen to use. Times have moved on over the last few decades; GPs and clinicians are more beholden to their patients these days. After all, we demand choice in every other area of our lives. So why would we simply accept the surgeon we are sent to? Or the implant that he or his hospital like to use routinely but which may not be the best?
Choose your implant – then your surgeon
Indeed, Tuke believes that anyone who is prescribed for hip or knee replacement surgery should first choose the best implant. This requires a certain amount of research, but is easier than you might imagine, thanks to The National Joint Registry (NJR) and the internet.
“This is a government database, open to everyone, which records information on all joint replacement surgery in the UK,” says Tuke. “If anyone needs a follow-up procedure, information about that is also registered. It records why the surgery was necessary and which hospital carried out the operations. It then shows how long each implant brand is likely to be effective, because some underperform against national averages and some consistently have lower re-operation (revision) rates year on year.
“Then there is the Orthopaedic Data Evaluation Panel — or ODEP — which provides a scoring system for devices and their success rates.”
Manufacturer websites also provide information, which can be evaluated for marketing vs factual content, patients should not be put off learning how implants work. Try finding which total knee implants provide the optimum medial stability in the walking range of motion, there are only three! Patients can have better function and greater chance of being able to forget about their knee while doing everyday activities if the implant provides the normal amount of stability and allows the normal range of motion needed for those activities.
Once patients have chosen the implant they believe is best, they can ask to receive treatment from a surgeon who has demonstrated good results with that particular device.
It shouldn't be surprising to do it that way around, says Tuke, because most consumers will look for a brand they prefer first — from the coffee they drink to the car they drive — and then find out where to get it. While the total cost of a hip or knee replacement in the UK is around £10,000 – £12,000, the implant itself is only around £1,000 - £2,000. “The best implants do, generally, cost a bit more but are not the big part of the operation cost,” says Tuke. “But why would anyone want anything but the best device?”
The National Joint Registry also records information about individual surgeons so anyone can see the results of their operations. “It's tempting to think that all medical practitioners have the same level of experience and skill — but that's simply not the case,” says Tuke. “For example, if a surgeon has only performed six knee operations a year when the national average is 56, a patient may decide to go elsewhere.”
The importance of physiotherapy
The fact is that a knee or hip replacement is a major operation; so, ideally, a patient will only want to have it done once and some implants have the potential to last longer than others. “That's why it's so vital to get the right one the first time at any time of life,” says Tuke. “This is an implant that it is hoped is going to be an integral part of your body for the rest of your life. You don't want it to wear out early and need a re-operation when old and frail. People should have more control and more say about what kind and brand of implant it is, and who will be carrying out the surgery. It's about being brave enough to say something to your GP and/or consultant — and realising that if you don't ask, you don't get.”
Something else that joint replacement patients might not realise is that pre- and post-op physiotherapy is hugely important for early rehabilitation. Physiotherapy isn't always available because of cutbacks; but Tuke insists that its long-term benefits should not be underestimated.
“These can be immense,” he says. “Keeping the blood flowing and the joints moving without overdoing it is key. It might hurt a bit to stay active right up to the operation, but much more satisfactory outcomes can be achieved as a result. That's particularly true for people who want to get back to any sporting activities. I've seen squash players get back on the court within months of a joint replacement operation. With the right implant and the right care, almost anything is possible.”