Title: Knee Replacement Abroad: Where You Can Check the Surgeon Author: Arthur Harmash Published: 2026-09-21 (updated 2026-09-30) Source: https://lymyvoyage.com/articles/joint-registry-revision-rates-abroad Citations: - https://www.njrcentre.org.uk/surgeon-and-hospital-outcome-publication/ - https://aoanjrr.sahmri.com/documents/d/guest/2025-lay-summary-supplementary-report-aoanjrr - https://academic.oup.com/ije/article/54/4/dyaf078/8164297 - https://sar.registercentrum.se/about-the-register/how-the-register-works/p/SJWmPxGyo - https://pmc.ncbi.nlm.nih.gov/articles/PMC11760185/ - https://www.njrcentre.org.uk/njr-data-management/ - https://pmc.ncbi.nlm.nih.gov/articles/PMC12636846/ --- If you are having a knee replaced in England, you can look up the consultant by name before you agree to anything. The National Joint Registry publishes activity and outcome data for named individual surgeons and named hospitals on a free public website, so patients can "make informed decisions about their care".[^1] If you are having the same operation in Bangkok, Istanbul or Cancún, there is no equivalent page. That is not because those hospitals are worse. It is because nobody collects the number. Knee replacement abroad costs a third of the Western price. Every comparison table shows the price. None of them shows how often the implant has to be redone. Why is the second number so much harder to find? The number exists because some countries decided to count. Sweden has tracked joint replacements since 1979, Norway since 1987, Australia since 1999. Australia's registry now captures about 99 out of every 100 joint replacements performed in the country. Counting changes what you can see. Australia's registry follows 37 modern knee implant combinations out to ten years. The share of those operations that ended in a second operation ranges from 2.8% to 9.2%, depending on which implant was used. That is more than a threefold difference in the same country, in the same decade. Now look at the destinations that sell the operation. An international survey of joint registries covers two dozen countries, from the Nordic states and the UK to Japan, Egypt, South Africa and India. Thailand, Turkey and Mexico do not appear in it. India is the exception worth being careful about. It has had a joint registry since 2006, and reporting to it is voluntary. Roughly 27,000 knee replacements were entered for 2019, against an estimated 200,000 performed in the country in 2020. A registry that sees one operation in eight cannot tell you about the hospital you picked. None of this shows that surgery is worse in Bangkok than in Birmingham. It shows something narrower and more awkward. In the countries that sell the trip, the evidence that would settle the question has not been gathered, so nobody can answer it either way. ## What a registry actually lets you look up A joint registry records every hip or knee replacement, which implant was used, and whether the patient came back for a revision. A revision is a second operation to replace or repair the first implant, and it is the standard measure of whether a joint replacement worked. The point of counting is that the answer is not uniform. The Australian Orthopaedic Association's registry followed 37 modern total knee replacement combinations that have at least ten years of data, covering 89.2% of all the total knee procedures it holds. The proportion revised within ten years ranges from 2.8% to 9.2% depending on the combination used.[^2] The spread is wider for hips over a longer window. Among prostheses with 15 years of follow-up, the share revised runs from 4.4% to 17.8%.[^2] The registry also names the devices performing worse than expected each year, in a chapter called "Prostheses with a Higher than Anticipated Rate of Revision".[^2] That is the information a knee patient is actually choosing between. It is invisible without a registry. ## Where the registries are, and what they publish | Country | Registry since | Coverage | Results published down to | |---|---|---|---| | Sweden | 1979 (hips)[^3] | 98.1% of total hips, just over 97% of knees[^4] | Register reports; national and unit data[^4] | | Norway | 1987[^3] | Not verified for this article | National reports[^5] | | Finland | 1980[^3] | Not verified for this article | National reports[^5] | | Australia | 1999[^3] | About 99% of all procedures[^3] | Implant combination, with named outlier devices[^2] | | United Kingdom | Mandatory submission; 4.6 million records[^6] | About 95% of primary procedures[^6] | Named consultant surgeons and named hospitals[^1] | | India | 2006, voluntary[^7] | About 13% of national volume[^7] | National summaries only[^7] | | Thailand, Turkey, Mexico | No registry found[^5] | — | — | The international picture comes from the International Society of Arthroplasty Registries, which in 2025 published a standardised comparison of its member registries in *Acta Orthopaedica*. Twenty-five of its 29 member registries completed the template. Hospital coverage among them ranged from 12% to 100%, and 21 produced publicly available annual reports.[^5] The member countries in that paper include the Nordic states, the UK, Germany, the Netherlands, Italy, Canada, the United States, Australia, Japan, Egypt, South Africa and India.[^5] Thailand, Turkey and Mexico are not among them. No national joint registry publishing comparable revision data could be located for those three countries for this article. ## India has a registry, and it sees about one operation in eight The working version of this story, repeated in a lot of medical-travel writing, is that the big destination countries have no registries at all. For India that is wrong, and the correction matters. The Indian Society of Hip and Knee Surgeons started a joint registry in 2006. It grew from 1,019 knee replacements reported in its first year to about 27,000 for 2019, with 712 participating surgeons by June 2020.[^7] The limitation is coverage, not existence. A 2025 review in the *Journal of Orthopaedic Case Reports* sets those 27,000 registered cases against roughly 200,000 knee arthroplasties performed in India in 2020, which is about 13%.[^7] The same review names voluntary participation, reporting bias concentrated in certain hospitals and the absence of mandatory standards as the registry's central weaknesses.[^7] A registry at 13% coverage and one at 99% are not the same instrument. The Indian registry can describe national patterns. It cannot tell a patient whether the specific hospital they were quoted has a revision rate above or below average, because it does not publish at that level.[^7] ## What the registry countries cannot tell you either **Coverage is not outcome.** A registry tells you how often an implant was removed, not how much pain the patient was left in. Revision is a hard, countable event, which is exactly why registries use it, and it misses patients who are unhappy but never reoperated. **Even good registries vary enormously.** Hospital coverage across the international society's own members runs from 12% to 100%.[^5] Membership of a registry network is not by itself evidence that a country's numbers are complete. **Surgeon-level figures need careful reading.** A surgeon taking on complex or high-risk cases will show worse raw outcomes than one who does not. The British publication exists to inform patients, not to rank surgeons by a single number.[^1] **The absence of data is not evidence of bad results.** No registry in Thailand, Turkey or Mexico means no published comparison, in either direction. Private hospitals there may well audit their own results internally, and some certainly do. A patient simply cannot see them. ## What to ask instead Ask the hospital directly for its own revision rate for your operation, over a defined number of years, and for the number of cases that rate is based on. A hospital that audits itself will have the figure. One that does not will change the subject. Ask which implant will be used, by manufacturer and model. Then check that implant in the Australian or British registry reports, which are free to read and cover devices sold worldwide.[^2] The implant travels even when the registry does not. Ask who performs the revision if it is needed, and who pays. The revision is the event the registries are built to count, and it is the event a plane ticket complicates most. Finally, treat a missing number as a missing number. In England the revision rate of a named surgeon is a fact you can look up before you book.[^1] For most medical-tourism destinations it is not a worse number. It is an absent one, and those are not the same thing. [^1]: https://www.njrcentre.org.uk/surgeon-and-hospital-outcome-publication/ — National Joint Registry (hosted by the Healthcare Quality Improvement Partnership), "Surgeon and Hospital Outcomes Publication". Accessed Sep 20, 2026. [^2]: https://aoanjrr.sahmri.com/documents/d/guest/2025-lay-summary-supplementary-report-aoanjrr — Australian Orthopaedic Association National Joint Replacement Registry (South Australian Health and Medical Research Institute), "Lay Summary Supplementary Report", 2025 Annual Report. Accessed Sep 20, 2026. [^3]: https://academic.oup.com/ije/article/54/4/dyaf078/8164297 — Y. Zhou, C. J. Wall, J. Stevens and others, "Data Resource Profile: The Australian Orthopaedic Association National Joint Replacement Registry", International Journal of Epidemiology vol. 54 no. 4 (2025), which also dates the Swedish, Finnish and Norwegian registries. Accessed Sep 20, 2026. [^4]: https://sar.registercentrum.se/about-the-register/how-the-register-works/p/SJWmPxGyo — The Swedish Arthroplasty Register, "How the register works", reporting completeness calculated against the National Board of Health and Welfare's patient register. Accessed Sep 20, 2026. [^5]: https://pmc.ncbi.nlm.nih.gov/articles/PMC11760185/ — A. Lübbeke and others for the International Society of Arthroplasty Registries, "Arthroplasty registries at a glance", Acta Orthopaedica vol. 96 (published Jan 24, 2025), pages 116-126. Accessed Sep 20, 2026. [^6]: https://www.njrcentre.org.uk/njr-data-management/ — National Joint Registry, "How the NJR manages your data", on mandatory submission, record volume and coverage. Accessed Sep 20, 2026. [^7]: https://pmc.ncbi.nlm.nih.gov/articles/PMC12636846/ — K. Aneja, P. K. Machaiah and A. Shyam, "The Indian Joint Registry: Building Trust, Safety, and Excellence in Indian Orthopedics", Journal of Orthopaedic Case Reports vol. 15 no. 11 (published Nov 2025), pages 439-445. Accessed Sep 20, 2026.