Redefining Outcomes in Total Knee Replacement Surgery (TKR)

Total Knee Replacement (TKR) remains the most commonly performed elective orthopaedic procedure globally. Despite significant advancements in surgical methodologies and implant technologies, post-operative outcomes can be variable, with up to 20% of patients expressing dissatisfaction following surgery. The Complex Knee Clinic, established at the National Orthopaedic Hospital in 2018, convenes bi-monthly under the direction of Consultant Orthopaedic Surgeons Professor John O’Byrne, Mr Peter Keogh, Mr Adrian Cassar-Gheiti, Mr Sven O’hEireamhoin, Mr Andrew Hughes, and Physician Associate Ms Ciara Doran.

Serving as a National Referral Centre, the clinic provides comprehensive multidisciplinary evaluations involving multiple consultants. Patients referred to the clinic generally fall into one of the following categories:

Every patient undergoes an exhaustive assessment by a minimum of three orthopaedic specialists and thorough investigations with multiple modalities. Where surgical intervention is warranted, operative procedures are typically conducted jointly by two consultant surgeons. Select cases necessitate the involvement of plastic surgeons, facilitated through collaborations with Beaumont Hospital, Connolly Hospital Blanchardstown, and the Mater Hospital. Since its inception, the clinic has managed over 500 cases from across Ireland from both public and private hospitals.

The demand for this specialised service continues to increase, highlighting the need for future expansion and additional resources. A significant proportion of complex cases require coordinated input from visiting plastic surgeons and infectious disease specialists at the National Orthopaedic Hospital Cappagh (NOHC). Owing to the intricate and often prolonged nature of these procedures, coupled with the utilisation of advanced and high-cost implants, the clinic incurs substantial operating costs. The patient population is characterised by complexity, necessitating comprehensive pre-operative optimisation and intensive rehabilitation. Individuals referred with prosthetic joint infections frequently undergo multiple surgical interventions, incorporating prolonged, high-cost antibiotic regimens and multidisciplinary collaboration among orthopaedic and plastic surgeons, microbiologists, and infectious disease experts.

NOHC is a National Centre of Excellence in Orthopaedic Medicine. A team of experts deal with complex surgical referrals, a service which is not available elsewhere in either the public or private system in Ireland. Collaboration and input from the expert team ensures the optimal outcome for patients, and feedback has been exceptional.