How to Choose a Knee Replacement Surgeon: A Checklist From an Insider

Published June 2026.

I am a joint replacement surgeon, so I have an obvious bias in writing this. Let me set the ground rules up front: nothing on this list requires you to choose me, and every item is exactly what I would check, point by point, if someone in my own family needed a knee replaced and I could not do the operation myself.

Most people pick a surgeon from a referral and a quick scan of online ratings. Both have some value. Neither tells you the things that actually shape how your operation goes — and those things are knowable, if you know what to ask. If you are still deciding whether you need a surgeon at all, start with my guide on orthopedic surgeons vs. non-surgical specialists and come back here once surgery is genuinely on the table.

1. Are They Fellowship-Trained in Adult Reconstruction?

Fellowship training in adult reconstruction means a surgeon spent a full additional year after residency doing almost nothing but hip and knee replacement. Residency makes someone an orthopedic surgeon. A fellowship makes them a subspecialist: a year of high-repetition training in primary joint replacement, complex deformity, and — importantly — revision surgery for joints that have failed.

How to check: read the surgeon’s bio, then ask directly: “Where did you do your fellowship, and was it in adult reconstruction?” Surgeons list this proudly — my own training background is on this site, including my adult reconstruction fellowship at Stanford. If a bio is vague about fellowship training, that is worth a direct question at the consultation. A general orthopedic surgeon can legally perform a knee replacement; the question is whether joint replacement is the center of their practice or one of many things they do.

2. How Many Knee Replacements Do They Perform Each Year?

In a large Medicare study, patients whose surgeons performed more than 50 knee replacements a year had a lower risk of any serious perioperative complication — death, pneumonia, pulmonary embolism, heart attack, or deep infection — than patients of surgeons doing 12 or fewer per year (odds ratio 0.81) [1].

The same study found the hospital matters too: facilities doing more than 200 knee replacements a year had a lower risk of adverse outcomes than those doing 25 or fewer (odds ratio 0.74) [1]. Two honest caveats. First, these are perioperative complications — the weeks around surgery — not long-term implant survival. Second, volume is a proxy, not a guarantee; there are excellent moderate-volume surgeons and busy mediocre ones. But the difference between a surgeon who replaces knees every week and one who does a handful a year is real, and the question is fair. The American Academy of Orthopaedic Surgeons explicitly advises patients to ask their surgeon how many joint replacements they perform each year [2].

3. Who Actually Performs Your Operation?

The name on your consent form should be the person standing at the table for the parts of the operation that determine your outcome. In teaching hospitals, residents and fellows participate in surgery — that is how I was trained, it is how the next generation learns, and it is not a problem when it is supervised and disclosed. What you want to avoid is being surprised.

Ask plainly: “Will you personally perform the bone cuts and position the implants? Who else will be in the room, and what will they do?” A confident surgeon answers in one breath. Hesitation, or an answer that talks around the question, tells you something useful.

4. Do They Offer Modern Techniques — and Are They Honest About What Those Techniques Do?

Robotic assistance makes a knee replacement more accurate; it does not make it categorically safer, and a surgeon who claims otherwise is overselling. I use robotic-assisted knee replacement in my own practice because I value the precision in implant positioning and alignment — but the robot is a tool that executes the surgeon’s plan, not a substitute for judgment.

The same logic applies across joint replacement: for hips, the equivalent conversation is about the direct anterior approach. The point of this checklist item is not that you must have a robotic operation. It is that your surgeon should be fluent in the modern options, able to explain in plain language when they matter and when they do not, and candid about their limits. How a surgeon talks about technology is one of the fastest ways to gauge their honesty. “It helps me put the implant exactly where I planned it” is a trustworthy answer. “The robot does a better job than any human” is marketing.

5. Can They Offer Outpatient Knee Replacement If You Qualify?

A practice built for outpatient joint replacement tells you something about its entire system: anesthesia protocols, pain management, blood-loss control, and patient selection all have to be modern for same-day discharge to work safely. Even if you personally end up staying a night, a surgeon who routinely sends appropriate patients home the same day is running a current-generation operation.

The equally important half of this item: a good surgeon will tell you when you are not an outpatient candidate, and why — age, heart or lung conditions, home support, and other factors all play in. If you want to understand how that selection works, I wrote a separate guide on who qualifies for outpatient knee replacement. Be wary of anyone who promises same-day surgery to everyone, or who dismisses outpatient surgery entirely without discussing your specific health profile.

6. How Do They Talk About Complications and Revisions?

In one large single-center series of 781 revision knee replacements, the leading causes of failure were implant loosening (39.9%) and infection (27.4%), followed by instability (7.5%) — with infection driving most early failures and loosening most late ones [3].

Why does that matter when you are choosing a surgeon for a first-time knee replacement? Because a surgeon who is comfortable with revision surgery understands failure modes from the inside — and that understanding changes how they do the primary operation: how they balance the knee, how they fix the implant, how seriously they take infection prevention. Ask: “What are the most common ways this operation fails, and what would we do if it happened to me?” A surgeon who answers specifically, without flinching, is showing you experience. One who waves the question off — “that won’t happen” — is showing you something else. If you ever need it, I have also written about the warning signs of a failed knee replacement.

7. Will They Show You Your Own Images?

My rule is to treat the patient, not the X-ray — and you cannot do that without putting the patient’s X-ray on the screen and walking through it together. You should leave the consultation having seen your own images and understanding, in plain terms, why surgery is or is not justified by what they show.

This cuts both ways. A severe-looking X-ray in a patient with mild symptoms is often a reason to wait, not operate. Significant symptoms with modest X-ray changes deserve a careful search for what else might be going on before anyone talks about implants. If a surgeon recommends a knee replacement without showing you the imaging that justifies it, ask to see it. The response to that request is itself diagnostic.

8. Do They Explain the Alternatives Honestly — Including the Limits of Surgery Itself?

A systematic review found that roughly 10% to 34% of patients — about 20% in the best-quality studies — report some degree of persistent pain after knee replacement [4]. Most patients do very well, and most of that pain is mild, but a knee replacement is not a guarantee of a pain-free knee, and you deserve to hear that from the person recommending one.

The same honesty should apply to the non-surgical side. The AAOS knee osteoarthritis guideline gives its strongest (“Strong”) recommendations to exercise and topical NSAIDs, rates knee braces and weight loss “Moderate,” and rates acupuncture, TENS, and oral supplements such as glucosamine and turmeric only “Limited,” meaning the evidence is weak or inconsistent [5]. A surgeon worth your trust will lay this landscape out plainly: what is still worth trying before surgery, what is unlikely to help, and what the operation can and cannot deliver. If every alternative gets dismissed in a sentence, or the persistent-pain conversation never happens, keep looking.

9. Do They Have Financial Relationships With Implant Companies?

Every payment a device or drug company makes to a US physician is publicly searchable in the federal Open Payments database — and looking your surgeon up takes about two minutes [6]. Some orthopedic surgeons receive payments from implant manufacturers for consulting, speaking, or research. These relationships are not automatically bad; implant design genuinely needs surgeon input. But they are worth knowing about, because a surgeon with no conflicts can choose the implant that is best for you, not the one they are paid to use.

Ask directly: “Do you have any financial relationships with implant companies?” Then check the database. A surgeon who answers transparently and whose answer matches the public record has just demonstrated the kind of honesty you want in the operating room.

10. Do You See Any Red Flags?

No ethical surgeon guarantees a surgical outcome. That single rule will protect you from most of the bad actors. Beyond it, watch for:

• Guarantees: “You’ll be pain-free” or “this implant lasts forever.” Surgery has probabilities, not promises.
• Pressure: urgency to book an elective operation this week. Knee arthritis is almost never an emergency; a real surgical indication will still be there in a month.
• Dismissed questions: if your questions irritate the surgeon during the consultation — the easiest part of the relationship — imagine the conversation after a complication.
• Surgery recommended without a real evaluation: no examination, no review of your imaging with you, no discussion of alternatives.
• Hostility toward second opinions: confident surgeons welcome them.

If you hit one of these, get another opinion before committing. If travel or scheduling makes that hard, a virtual second opinion is a low-friction way to have your imaging and recommendation reviewed by another fellowship-trained surgeon.

Green Flags vs. Red Flags at a Glance

What Questions Should You Bring to the Consultation?

The American Academy of Orthopaedic Surgeons publishes a list of questions patients should ask before joint replacement — including whether you truly need surgery and what the risks of waiting are, what the surgeon’s own outcomes and complication rates look like, and how many joint replacements they perform each year [2]. Those questions overlap heavily with this checklist, which should tell you something: the professional body that represents surgeons wants you interrogating us this way.

Consultations go fast, and it is easy to forget the question that mattered most to you. We have combined the AAOS questions with the items in this article into a single page of questions to ask your joint replacement surgeon, including a printable PDF you can bring to any consultation — mine or anyone else’s.

About Dr. Leo Zalikha: Precision Joints, Long Beach

Frequently Asked Questions

References

1. Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am. 2004;86(9):1909–1916. PMID: 15342752. PubMed
2. American Academy of Orthopaedic Surgeons (OrthoInfo). Total Hip and Knee Replacement: Questions Patients Should Ask Their Surgeon. orthoinfo.aaos.org. OrthoInfo
3. Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today—has anything changed after 10 years? J Arthroplasty. 2014;29(9):1774–1778. PMID: 25007726. PubMed
4. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012;2(1):e000435. PMID: 22357571. PubMed
5. American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee (Non-Arthroplasty): Evidence-Based Clinical Practice Guideline. 3rd ed. Rosemont, IL: AAOS; 2021. AAOS
6. Centers for Medicare & Medicaid Services. Open Payments Database. openpaymentsdata.cms.gov

Medical Disclaimer: This content is intended for general educational purposes and does not constitute medical advice. Individual results and treatment recommendations vary based on diagnosis, health history, and imaging findings. Please consult with Dr. Zalikha or a qualified orthopedic physician for an evaluation specific to your condition.