Are you looking for a surgeon finder? When it comes to selecting an ankle surgeon, it is important to ensure your surgeon has the correct skill to perform your operation. Whilst this article is about finding a surgeon to perform an ankle replacement in England, it’s content can be used for any surgeon for any condition.
How do I find the best UK ankle replacement surgeon?
When it comes to undergoing surgery that’s going to last your lifetime, it’s important to make sure you select your surgeon based on their ability to do the best job for you. We recommend that you do your own homework in finding the most appropriate surgeon for you.
Now of course, personal recommendation by a friend or family member is a much better way for you to find the best surgeon. However, as you will see from this article, should only form part of your search.
Speak to your GP
In the UK, general practitioners or GP’s are the first port of call for any medical problem. In many cases your GP will have looked after you or your family for a long time and they know you well.
All patients that have seen a specialist come back to the GP eventually. So the GP tends to form their own mini TripAdvisor for health and are an excellent place to start.
If you are being referred on the NHS, you may have less choice as to whom you can see. This is largely because primary care Trusts now have contracts with certain hospital providers. Therefore you are likely to be referred within contract to your local hospital. There is however the NHS e-Referral Service, which replaced Choose and Book in June 2015 and gives you some choice as to whom you can see.
In many cases, the NHS will refer you to a local musculoskeletal triage service. This is a form of filter to reduce the number of referrals to specialists. This can be useful if you have a common minor ailment such as low back pain. Unfortunately, this can delay referral when conditions are serious or more complex such as ankle arthritis.
Even if your GP doesn’t know a specific specialist for your problem, they are good sounding boards for your research.
If you are seeking a private appointment you are likely to also need a GP referral in order to obtain an appointment with a specialist. Some insurers have introduced a system known as Open referral. Whereby a GP cannot recommend any specialist and it has to be a “Dear Doctor” letter. In certain circumstances this can be dangerous, as health insurers who have introduced this policy rarely have the necessary quality metrics to know who is the most appropriate specialist for you to see
Search the Internet
Internet sites can help you find surgeons, but often search is paid for and this means that you are just responding to an advert. There are many patient review sites now such as I Want Great Care where you can read other patients reviews. Chat rooms, where patients make personal recommendations based on their own outcome can be very useful. If there are several recommendations rather than just one, that is likely to be a more reliable source.
Check the surgeon’s credentials
Read the surgeon’s biography. Have they obtained all the appropriate qualifications? In orthopaedic surgery, surgeons should have a basic medical qualification such as MBBS. Then an orthopaedic Board certification which is known as FRCS(Orth) or FRCS (Tr&Orth). Other surgeons may have an MD, which in the UK is a higher research degree as is a PhD.
Podiatric surgeons are not medically qualified. Some podiatric surgeons work as part of an established orthopaedic network. In this guise, they are suitable to perform forefoot surgery up to the midfoot but should not be performing ankle replacement surgery outside of a secondary care setting in an orthopaedic network, with the appropriate governance in place. Do not be afraid to obtain details of their governance structure and feel free to check a surgeons credentials with the British Orthopaedic Foot & Ankle Society (BOFAS).
You can check a surgeon’s qualifications on the General Medical Council’s (GMC) website.
If you are searching for a surgeon to perform an ankle replacement, you can search the number of cases your surgeon performs a year on the UK National Joint Registry for Ankle Replacements.
Questions to ask your surgeon
It’s always good to have a list of questions to ask your surgeon. Some of these are general questions to ensure you are undergoing the correct procedure and others relate to them being the best person for the job.
It is important to have confidence in the doctor who will be doing your surgery. Whether this is someone you have chosen yourself, or a doctor or surgeon you have been referred to. You can make sure that he or she is qualified. This may include any or all of the following:
How many of these operations do you perform a year?
The median number (or the commonest number) of ankle replacements performed per year by surgeons is three. There are a handful of surgeons that perform large numbers per year and there is good evidence that centres that do more of something get better outcomes.
In the case of ankle replacements, there is a National Joint Registry for Ankle Replacements. This contains details of all ankle replacements performed both in the NHS and in the private sector. Putting information onto the NJR is a mandated requirement. You may ask the surgeon about his or her record of successes, as well as complications.
Should I seek a second opinion?
In certain cases, such as complex problems, or revision surgery, you can never have enough opinions. A good specialist would be very happy to recommend another surgeon for you to have a second opinion from. Be cautious of anyone who tries to talk you out of seeking a further opinion.
What is the operation being recommended?
A good surgeon will explain the procedure in simple terms that are easy to understand. If not then ask questions until you fully understand.
Is there an alternative to this operation?
Ask if there is an alternative to the surgery being recommended. In the case of ankle arthritis, you must always try non-operative methods first. If surgery is required, both ankle fusion and ankle replacement are both accepted surgical treatments. You should be allowed to understand both procedures before deciding which to undergo. If your doctor favours one treatment over another ask why.
Why is the procedure needed?
Reasons to have surgery vary from treating pain, or improving function. It is important that you explain your expectations at the outset so that your doctor can tell you whether they will or will not be met.
What are the possible risks and complications of surgery?
Surgery always carries some risks, so it is important to weigh the benefits against the risks of surgery. In the case of ankle replacements the published re-operation rates suggest that there is a 6% of needing a second procedure within 12 months of the index procedure and about 20% of ankle replacements have failed within 10 years. Nowadays revision to another ankle replacement or conversion to an ankle fusion are both possible.
What happens if I decide not to have the operation?
Before trying surgery, consider many non-surgical treatments, such as weight loss, activity modification, pain killers and ankle braces. Have these been tried and failed?
If you decide, after weighing the benefits and risks, not to have the surgery, what will happen? Could it resolve by itself? Will it worsen? If so what are the implications of that?
What type of anaesthetic will I have?
Your surgeon will discuss the different types of anaesthetic including local, regional, or general anaesthesia. Its important for you to understand how your pain will be controlled after the surgery.
What will my schedule of follow up visits be?
Ask whether you will be seen after the surgery for a wound check and removal of stitches and what the schedule will be thereafter. For most complex ankle procedures you will be seen at 2, 6 and 12 weeks after the procedure. For an ankle replacement, you will also need a follow up at 1 year. It is important that you confirm with your health insurer that you will be covered.
Will I need any additional drugs or equipment?
The National Institute of Healthcare & Clinical Excellence (NICE) has set guidance on the use of treatments to reduce the risk of blood clots. Your surgeon will need to risk assess you and discuss the correct options for your case depending on whether you will be immobilised after the surgery. After the surgery you may need low molecular weight heparin (e.g. Tinzaparin or Clexane). It is important that you understand this before the surgery so you can plan, both the logistics of how this will be administered as well as whether or not the costs will be covered by your insurer.
You may also need a postoperative elevator to reduce swelling, a waterproof protector, crutches or a knee scooter, a special boot or ankle brace and changes of plaster cast. It is important you fully understand these costs before beginning and also checking with your health insurer what they will and will not cover. Knowing this information in advance will help you recover better without the stress.
What are the costs of this operation?
Similarly, it is important to fully understand the costs of the surgery before you begin. In the NHS, surgery is free for eligible patients and so this is not relevant. In the private sector it is essential you are fully aware of all costs before you begin. The costs include the surgeon’s fee, the anaesthetist’s fee, the hospital charges and any additional drugs or equipment that are needed. In addition, depending on how many follow up appointments are needed and whether or not you need to have the plaster cast changed.
Some hospitals will do package costs so that all charges are included. In others, it is essential you are fully aware of what sort of costs you may be liable for before beginning. Even if your insurer tells you that all costs are covered, it is worth asking them for an itemised breakdown of the costs.
Other top tips for communicating with your surgeon
It is important that you have all your questions answered fully before you begin. If you do not understand your surgeon’s answers, say so and keep asking questions until you do.
Feel free to take notes of your consultation or ask a friend or relative to do so. Ask your surgeon to confirm your discussion in writing afterwards.
Ask your doctor for a patient information sheet or online sources of information to read more about your surgery.
Finding a surgeon to perform an ankle replacement
We cannot recommend the UK’s best or top orthopaedic surgeon, nor any one surgeon over another. You will need to do your own homework as guided by this article.
Go and see them and use this framework to ask the right questions. No matter whether your insurer is BUPA, AXA PPP, Aviva, PruHealth, Simply Health, Cigna, WPA, or Simply Health. Remember, this is a procedure you only want to be performed once, so it’s important to get it right the first time.
Good luck…
This article was written by the London Ankle & Arthritis Centre. Please feel free to contact us on +44(0)207 042 1828 if you have any queries or would like to find a specialist.
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