Hip & Knee Second Opinion — Before Surgery, Before Revision

A second opinion is an independent educational review of your diagnosis, imaging, and proposed treatment by a different orthopedic specialist. AAOS and AAHKS support second opinions for elective hip and knee surgery as part of shared decision-making.

Most reviews require recent X-ray, MRI, or CT (on disc or PACS link), the radiology report, any prior operative report and implant ID card, recent labs (CBC, ESR, CRP if infection is a concern), medications, comorbidities, prior PT notes, and current surgeon office notes (AAOS; AAHKS).

Many initial second opinions are completed remotely from records and imaging. An in-person examination is typically required if surgery is being considered or if findings on imaging are ambiguous. Telemedicine rules vary by jurisdiction.

Pricing varies. Some programs include educational second opinions at no cost to qualify a case; formal medical second opinions through US hospitals are commonly billed to insurance under E/M codes. Always confirm any fee in writing before sending records.

Many US commercial plans and Medicare cover a medically necessary second opinion (CMS). Coverage rules differ by plan. Contact your insurer for benefits specific to your policy.

An educational records review is often completed within several business days once a complete record set is received. Complex revision or infection cases may require additional imaging or lab work and can take longer.

Before any revision hip or knee replacement. AAHKS specifically supports verifying the indication, the mechanism of failure (loosening, wear, instability, infection), and the surgical plan with a high-volume revision specialist.

MSIS criteria and AAHKS guidance commonly include ESR/CRP, joint aspiration with cell count and culture, and selected biomarkers (e.g., alpha-defensin). Reviewing infection workup is one of the most common reasons to seek a second opinion before revision.

Yes. Cemented, cementless, cruciate-retaining, posterior-stabilized, medial-pivot, and dual-mobility designs each have evidence bases in the AJRR, NJR, and AOANJRR registries. A second opinion can compare design rationale and registry survivorship for your anatomy and activity level.

Peer-reviewed literature (PubMed) and AAHKS position statements consistently associate higher annual TKA/THA volume with measured differences in complications and revision rates. Volume alone is not sufficient — fellowship training and program-level quality also matter.

Do not delay for clear emergencies — fever, drainage, severe pain, dislocation, sudden inability to walk, calf swelling, chest pain, or shortness of breath. Seek urgent in-person care first. A second opinion is for elective and semi-elective decisions, not emergencies.

Disagreement is common and often educational. Ask each surgeon to explain the reasoning: diagnosis, imaging interpretation, indication for surgery, implant choice, and expected outcomes. Choose the plan you understand best and that aligns with your goals.

Existing imaging is usually sufficient if it is recent and of diagnostic quality. Older studies, low-quality DICOM, or missing views (e.g., long-leg alignment X-rays before TKA) may require repeat imaging.

An educational records review does not, by itself, create a doctor-patient relationship. A formal medical second opinion delivered by a licensed clinician in the patient's jurisdiction may. Always confirm the scope of the review in writing.

Yes. AAOS clinical practice guidelines emphasize that non-surgical care (PT, weight optimization, injections, bracing) should be tried and documented before elective replacement. A second opinion can confirm whether all reasonable options have been explored.

Most US plans require documentation of conservative care, imaging, and functional impairment before authorizing arthroplasty. A second opinion can help patients confirm that the documentation supports the proposed CPT/DRG (CMS LCDs vary by region).

Yes. Many patients seek a second opinion after a surgery date is set. Most programs can complete an educational review without changing your scheduled date; the decision to proceed remains yours.

No. No reputable second-opinion service guarantees outcomes. Outcomes depend on diagnosis, anatomy, comorbidities, surgical technique, implant, and rehabilitation. Results vary. Be cautious of any program promising guaranteed results.

No. HipAndKnee.mx is an independent educational resource. It is not a certified healthcare provider, hospital, or insurer. All content is educational only and does not replace in-person evaluation by a qualified orthopedic specialist.