Choosing a knee surgeon is a big decision, and most people make it on the strength of a recommendation from a GP, physiotherapist, friend or family member.[1] A recommendation is a good place to start, but it also helps to know what you can check for yourself: the surgeon’s training, their experience with the operation you might need, and how clearly they explain your options, including the ones that don’t involve surgery.
At a Glance
- You can check any surgeon’s registration and specialty for free on the Ahpra public register.
- Experience with your particular operation is worth asking about, but it is only one factor.
- A good first consultation covers non-surgical options, risks, recovery and total costs.
- A second opinion isn’t routinely needed, but it is a reasonable option if you feel unsure about the treatment proposed.
What training should a knee surgeon have?
In Australia, an orthopaedic surgeon completes a medical degree, several years of hospital work and then around five years of specialist orthopaedic surgical training. Surgeons who finish this training become Fellows of the Royal Australasian College of Surgeons, shown after their name as FRACS (Orth). Most also become Fellows of the Australian Orthopaedic Association, shown as FAOrthA.
After this, some orthopaedic surgeons complete one or more fellowships. A fellowship is a further period of training focused on one area, such as the knee, and is often done at a major centre in Australia or overseas.
You can check any surgeon’s registration yourself on the public register of the Australian Health Practitioner Regulation Agency (Ahpra). It is free, and it shows whether the surgeon is registered as a specialist and in which specialty. In Australia, “specialist” is a protected title linked to a registered specialty. For a surgeon who operates on knees, that specialty is orthopaedic surgery.
Dr Vishal Pai’s registration and training
- Ahpra registration number MED0001219698, with specialist registration in orthopaedic surgery. You can look this up on the Ahpra public register.
- Fellow of the Royal Australasian College of Surgeons (FRACS) and the Australian Orthopaedic Association (FAOrthA).
- Two knee fellowships in the United Kingdom: at Southmead Hospital in Bristol, covering kneecap stabilisation and partial and revision knee replacement, and at the Fortius Clinic in London, covering sports knee surgery such as ACL and ligament reconstruction.
Does it matter how often a surgeon does your operation?
It is reasonable to ask a surgeon how often they perform the operation being suggested for you. Experience does matter, but the picture is more mixed than you might expect.
Patients of surgeons who do fewer knee replacements have higher infection rates, longer operations and hospital stays, and rate their knees worse afterwards. How long the knee replacement lasts, however, does not appear to depend on how many operations the surgeon does.[2]
In Australia, 1.5% of knees replaced by surgeons who do 100 or more knee replacements a year need further surgery for infection within 19 years, compared with 2.1% for surgeons who do fewer than 25 a year.[3] Infection needing another operation is uncommon in both groups.
The link is stronger for partial knee replacement, where only the worn part of the knee is replaced. When surgeons do 30 or more partial knee replacements a year, 92.4% are still in place after eight years, compared with 87.9% when surgeons do fewer than 10 a year.[4]
For ACL (anterior cruciate ligament) reconstruction, patients of surgeons who do more of these operations are a little more likely to rate their knee as acceptable two years later (46% compared with 38%). The chance of needing a repeat ACL operation, however, is no different.[5]
These figures describe large groups of patients. They can’t tell you how any individual surgeon will do, and the number of operations is only one part of the picture, alongside training, how well your options are explained and the care you receive afterwards.
Dr Vishal Pai performs more than 100 knee replacements a year. Whoever you see, you can ask how often they perform the particular operation suggested for you.
What should you ask at your first appointment?
Your first appointment is a chance to understand your knee and to see whether you feel comfortable with the surgeon. Useful questions include:
- What is causing my symptoms?
- What non-surgical options are there, and have I tried them properly?
- If surgery is suggested, how often do you perform this operation?
- What are the main risks, and what is a realistic recovery?
- Who will look after me after the operation, and how do I contact them?
- Which hospital would I go to?
- What are the total expected costs, including the surgeon, anaesthetist, surgical assistant and hospital?
Before any planned operation, you should receive written information about the expected fees. This is called informed financial consent.
Clear written information about your options helps. It improves people’s understanding of their choices and helps them feel better informed and take a more active part in decisions, without increasing regret afterwards.[6]
Dr Vishal Pai understands that it can be hard to take in everything discussed in a consultation. If surgery is being considered, he gives you detailed information sheets after the appointment that describe the procedure, its risks and the recovery, so you can read them in your own time.
If you have already chosen a surgeon and want to prepare for a conversation about the operation itself, the article on questions to ask your knee surgeon before surgery may help.
Do you need a referral, and what happens at the first consultation?
To claim the Medicare rebate for a specialist consultation, you need a current referral from your GP or from another specialist. A physiotherapist can recommend a surgeon, but a physiotherapist’s letter doesn’t attract the Medicare rebate. A GP referral to a specialist usually lasts 12 months.
It helps to bring:
- Any X-rays or MRI scans of your knee, with the reports.
- A list of your medicines.
- Your private health insurance details.
At the appointment, the surgeon will ask about your symptoms and how your knee affects your daily life, examine your knee and review your scans. They will then explain what is most likely causing the problem and talk through the options, which may not include surgery.
When does a second opinion help?
A second opinion isn’t something you routinely need. Most second opinions confirm the original diagnosis or treatment.[7]
If you feel uncertain about the treatment that has been proposed, though, a second opinion is a reasonable option, and it isn’t a judgement on the first surgeon. After a second opinion, people who had been recommended a knee replacement felt more confident in their decision, on average 7.8 out of 10 compared with 5.4 beforehand.[8]
If you would like one, ask your GP for a referral to the second surgeon and take your scans with you.
Summary
Choosing a knee surgeon starts with checks you can make yourself, such as registration and specialty on the Ahpra register and training in orthopaedic surgery. Experience with your particular operation is worth asking about, although it is one factor rather than a guarantee. A good first consultation explains the cause of your symptoms, the non-surgical options, the risks, recovery and costs. If you feel unsure about the treatment proposed, a second opinion is a reasonable step.
If you would like to discuss how this applies to your knee, you can book a consultation with Dr Vishal Pai.
References
Show all 8 referencesHide references
- Yahanda AT et al. 2015. A Systematic Review of the Factors that Patients Use to Choose their Surgeon. World Journal of Surgery.
- Lau RFL et al. 2012. The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature. BMC Musculoskeletal Disorders.
- O’Connor P et al. 2023. The Effect of Surgeon Volume on Revision for Periprosthetic Joint Infection. The Journal of Bone and Joint Surgery.
- Liddle AD et al. 2016. Effect of Surgical Caseload on Revision Rate Following Total and Unicompartmental Knee Replacement. The Journal of Bone and Joint Surgery.
- Rizvanovic D et al. 2024. Influence of Surgeon Experience and Clinic Volume on Subjective Knee Function and Revision Rates in Primary ACL Reconstruction: A Study from the Swedish National Knee Ligament Registry. Orthopaedic Journal of Sports Medicine.
- Stacey D et al. 2024. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews.
- Payne VL et al. 2014. Patient-initiated second opinions: systematic review of characteristics and impact on diagnosis, treatment, and satisfaction. Mayo Clinic Proceedings.
- Weigl M et al. 2021. Effects of a medical second opinion programme on patients’ decision for or against knee arthroplasty and their satisfaction with the programme. BMC Musculoskeletal Disorders.
Frequently Asked Questions
Is a knee specialist the same as an orthopaedic surgeon?
In Australia, the registered specialty is orthopaedic surgery, so “knee specialist” is not a separate registered title. Some orthopaedic surgeons focus mainly on the knee, often after extra fellowship training. You can confirm a surgeon’s specialty on the Ahpra public register.
Can I see a knee surgeon without a GP referral?
Many practices will see you without one, but you can’t claim the Medicare rebate for the consultation without a valid referral. A GP referral also means your GP receives a letter about your visit and stays involved in your care.
What if I'm not sure I need surgery at all?
That is a good reason to see a surgeon, not a reason to avoid one. Many knee problems, including most knee arthritis and many injuries, are first treated with exercise-based physiotherapy, weight management, medicines or bracing. A first consultation should explain whether surgery is likely to help you, and when it isn’t needed.
Choosing a surgeon for your knee?
Dr Vishal Pai is a knee surgeon in Melbourne. If you would like to talk through what is causing your knee problem and which options may suit you, including non-surgical ones, you can arrange a consultation.
Written by Dr Vishal Pai
Vishal is an experienced knee surgeon based in Bayside, Melbourne. He consults at Sandringham Orthopaedic Specialists and operates at The Avenue Hospital and Calvary Holmesglen Private Hospital. His practice focuses on sports knee surgery, including ACL reconstruction and meniscal repair, as well as robotic knee replacement.