Clinical Editor
Dr Sheila Strover is the Founder and previous Clinical Editor of the KNEEguru website.Her medical studies were completed at the University of the Witwatersrand in South Africa - BSc(Hons) (1968) and MBBCh (1974). She emigrated to the United Kingdom in 1983 and worked as an anaesthetist (anaesthesio…
What exactly is a knee surgeon? What qualifications and experience does a knee surgeon have?
There is no single identifying qualification that makes one a knee surgeon. So here are some guidelines for readers looking for a knee surgeon to help them with their knee problem
Let's start with basics. All knee surgeons are medically qualified and most have ordinary medical degrees, plus a specialist qualification in orthopaedic surgery. In some countries other medical disciplines may lead to one becoming a knee surgeon, such as osteopathy - but there still needs to be a sound qualification (eg doctor of osteopathy) plus a specialist surgical qualification.
In order to gain the specialist element, the doctor has to have undertaken several years of specialist surgical training, and sit an examination.
In the USA the basic qualification might be an MD, and the specialisation is likely to be a board certifcation. In the UK the basic qualification might be MBBCh (or MBChB) and the specialist qualification might earn the letters FRCS (Fellow of the Royal College of Surgeons). Other countries have their own systems and it can be all very confusing. In addition, a doctor may qualify in one country and then carry out the specialist training in another.
In addition, two surgeons may carry the same titles but in reality have very different experience and specialism - one may have focused on knee replacement while another focused on bone tumours, for example.
In reviewing the CVs of a surgeon, it is helpful to watch carefully for what appears to be 'name dropping' but which in reality is an acknowledgement having worked under important surgeon mentors. Many (but not all) knee surgeons will seek to travel to units that are highly experienced in the specialism in which they are interested, and which are headed by a 'big name' in knee surgery. These 'big name' mentors will have helped to train many junior surgeons, will have published many papers, and presented many papers at international meetings. They may have published or been the editor-in-chief of key medical books. They will have sat on the faculties of big medical meetings and participated in round-table discussions with leading peers. They will have participated in hand-on training workshops. Having experience under such a mentor is highly prized.
This travelling is highly regarded amongst peers. It may be arranged on a fairly casual basis, and visits range from a few days to a few weeks. The surgeon may pay for the travel him/herself or may be the beneficiary of a 'travelling fellowship' where the programme is paid for by a sponsor, often a professional body.
Individual 'Fellowships' of one or several years take this to a higher level, where a specialist unit under a key mentor may offer to take under their wing a young surgeon with the express intention of teaching them as much as they can about the specialism within this time frame.
So look out for a surgeon who has stated that he has undertaken one or more one-year or two-year Fellowhips under Dr 'BigName', because that will indicate that he/she is likely to have become skilled and knowledgeable during this period.
Most knee surgeons will have had to make an effort with research and teaching, publishing papers under the guidance of their senior departmental surgeon and presenting the results at local, regional and international meetings. Again, there is a strong concept of mentorship here. If the surgeon is relatively inexperienced, the more senior surgeon is likely to be in the audience and available to support the youngster to deal with audience questions. There is quite a lot of camaraderie here in the way the audiene deliberately challenges the presenter, and the young surgeon usually comes away wiping their brow and happy to have survived the challenge.
So look out in the surgeon's CV for mention of papers published (and the importance of any co-authors) and papers presented. These would have been hard won.
At a higher level, a surgeon becoming involved in a speciality like knee surgery will be invited onto a faculty of a meeting, where he/she will be able to become more intimate with other faculty members, and this allows the development of another level of camaraderie with colleagues where coffee-table discussions help to build up knowledge and allow important introductions.
Surgeons will state in their CV the organisations of which they are a member. This can be quite telling as some organisations insist on both a certain level of experience in their members as well as a personal endorsement by one or more existing members. In knee surgery such organisations include ISAKOS, ESSKA and many others which represent the letters of regional or international knee 'clubs'.
Most orthopaedic surgeons do a certain amount of knee surgery. But to be acknowledged as a 'knee surgeon' this percentage probably needs to be 40% to 100%. This is not always something that is easy for a prospective patient to find out unless one is prepared to ring the surgeon's office and enquire. Again, colleagues of the surgeon are likely to have a pretty good idea of the split of 'knee' and 'other' patients in the surgeon's practice, because they may have seen the numbers on slides at medical presentations, or they may have visited their colleague's practices.
So the long and the short of it all is that within the fraternity all the knee surgeons will know each other, who is a hyper-respected 'GodFather' (usually retired), who runs the important Fellowship programmes, who publishes widely,who travels widely, who sits on faculties, who has a special interest in what branch of knee surgery. But the ordinary man-in-the-street is locked out of this world, and only by perusing the CVS of orthopaedic and osteopathic surgeons can he hope to know who to consult with. There is no single qualification or title that will identify that person as a knee surgeon.
Because of this, the KNEEguru website maintains a database of knee surgeons around the world, together with an alphabetical list and a search engine to search by name or location. These lists are not complete, but will be a starting point for the reader needing help.