Many people know someone who has had a knee replacement. Many people think about getting one and look for a specialist. The medical term is "Total knee arthroplasty." The UpToDate from Wolters Kluwer article on it starts by referring readers to medical management of rheumatoid arthritis, and also cites a range of surgical options. The next paragraphs discuss knee replacement, because it is well-known, not because replacement is the first choice.
The 2012 D25 file (described in the Box) shows that the 20 highest volume Medicare providers are spread all over the country, in 13 states: Alabama, Arkansas, California, Colorado, Florida, Georgia, Illinois, Missouri, New Jersey, Oklahoma, South Carolina, Tennessee, and Texas. The 2013 file shows an overlapping list of doctors with high volume.
The websites of these high-volume doctors are worth exploring. If one of them accepts your insurance and you live nearby or have friends where you can stay during the long recuperation, you can consider going there.
Dr Bassett in Harlingen Texas has the highest volume in 2012 with 434 knee replacements. His website has a variety of information from Biomet (which makes joints). His website also says he teaches at the U of Texas, so many of his surgeries are likely done by residents. Consumer sites have several good reviews and one complaint about delays getting a cortisone shot. Dr Dearborn in Fremont California is second with 411 knee replacements. His web page does not say that he teaches; it does have a 10-page pdf description of alternative ways to do the operation and some of its risks. Two of his 12 written reviews on Vitals and one of 20 on AngiesList describe failed surgeries; the others describe successful outcomes or consultations
Wherever you live you can also look closer to home. For eample in the Washington DC region, Dr Dalury north of Baltimore did 211 knee replacements in 2012, and he teaches. Vitals mentions long waits for appointments, but all the consumer sites have praise and no complaints about outcomes. ProPublica says his patients have an average rate of readmissions to hospital within 30 days after surgery, for causes which could be related to the surgery. Checkbook does not list him.
If he is too far and you can accept doctors who do 2 per week instead of 4-8 per week, you can look in the immediate area around Washington (zip codes beginning with 20). The 2012 East file (also in the Box) shows the largest practices are Dr Cannova in Bethesda MD with 120 knee replacements, or Dr Peyton in Sterling VA with 88; neither teaches. One of many written comments on Dr. Cannova complains about a brief appointment and his approach, so the patient went elsewhere; otherwise much praise and no complaints about work he did. ProPublica found an average rate of readmissions for him, and says he operates at Suburban and Sibley hospitals. 14 of the 31 reviews for Dr Peyton complain about rudeness or long waits in the office to see assistants, little contact with the doctor, even in the hospital. Some of the positive reviews also say contact is generally with assistants; several express happiness with his surgery. ProPublica found a high rate of readmissions for him, and says he operates at Reston. Checkbook does not list Cannova or Peyton.
You can also search ProPublica and/or Checkbook for knee surgeons with low rates of readmission (and other complications at Checkbook). See Section B on another page. Remember that the major result, how well knees work after surgery, is still unknown, so you may want references and higher volume doctors within those lists, to try for the best knees, not just the lowest complications. You can search ProPublica by state. Maryland shows several hospitals, with graphs showing results of individual doctors. The lowest (best) point is in Annapolis, and when you click there, you find Dr. McDonald has lowest readmissions and the hospital billed for 782 knee replacements by him from 2009-2013 (5 years). He could be worth exploring. The Globe1234 files show he billed Medicare for 156 knee replacements in 2012 (deast), and 169 in 2013 (doc13sm). Dr. McDonald did not show up in the previous paragraph, based on zip codes beginning with 20, since his zip code is 21401.
You can search Checkbook by distance from a zip code. Searching within 75 miles of 20001 (downtown DC), it shows 13 knee surgeons with the lowest "bad outcomes", and you can click each one to see if volume is above average. They do not show detailed numbers on quality or volume, but you can get volume from this site or ProPublica. Dr. McDonald shows well there too. Checkbook's strength is its more thorough count of complications than elsewhere.
Some doctors' websites say why they recommend certain brands of knee joint. When patients see a doctor they can ask about the brands and approaches they have found on other doctors' sites.
These examples show the variation in patient comments, use of residents, and volume, which you might find in any field. Each patient or referring doctor can similarly search for Pain Management, Rheumatology and other specialties to find alternatives, though it is hard to be thorough when you are in pain or worried. If none of the first doctors you evaluate seems good enough, it's always possible to go back to the spreadsheets and find more candidates to consider. Second opinions help too. One patient said he went in to see about knee replacements, and the doctor said those could wait, but he needed 2 hip replacements, which he got and both went well. A a 2nd opinion would definitely seem appropriate.
Medicare and ProPublica tell you what payments each doctor received from medical companies. Biomet paid Dr Peyton $46,000 in royalties, so he may be quite expert on Biomet's joint. Patients need to decide if relationships with medical companies will strengthen or weaken their care. DocFinder and Pacer are ways to search for legal actions against any doctor you consider.
Your correspondent does not know or have any relation with any of these named doctors, and has been fortunate not to need a knee replacement, so there is no personal knowledge or bias here.
RETURN TO ARTICLE ON FINDING HIGH-VOLUME SPECIALISTS