The recommendation for a hip or knee replacement is one of the most far-reaching medical decisions in your life. An endoprosthesis will change your mobility, quality of life and everyday life for many years – often irreversibly. It is therefore completely understandable and sensible if you want to be fully informed and protected before taking this major step.
Since the end of 2020, as a person with statutory health insurance, you have been legally entitled to a free second opinion for planned hip and knee endoprosthesis operations. This regulation strengthens your position as a patient and enables you to make an informed, self-determined decision. In this comprehensive guide, you will learn everything you need to know about your right to a second opinion, the practicalities of the procedure and how to obtain the best possible medical advice for your situation.
Table of contents:
- What is a second medical opinion and when is it useful?
- Your legal right to a free second opinion
- Qualification and selection of the second opinion physician
- Documents required for the second opinion interview
- The second opinion procedure – step by step
- Indication check – when is a joint replacement really necessary?
- Alternative treatment options before the operation
- Quality features for the right choice of clinic
- Frequently asked questions (FAQ)
- Conclusion – Your health, your decision
What is a second medical opinion and when is it useful?
A second medical opinion is an independent, professional assessment of your medical case by a second qualified specialist. This specialist is not involved in your previous treatment and can therefore assess your situation completely objectively. The aim is to review the initial diagnosis, critically question the necessity of the recommended operation and suggest alternative treatment options. A second opinion gives you a solid, extended basis for deciding for or against the planned operation.
Several hundred thousand hip and knee arthroplasty operations are performed in Germany every year. This high number and regional differences in the frequency of operations have prompted legislators to introduce the structured second opinion procedure. A second opinion does not represent a breach of trust towards your attending physician, but is in line with the standard of modern, patient-oriented medicine and demonstrates responsible patient behavior.
A second opinion is particularly valuable in the following situations:
- In case of uncertainty about the necessity of the recommended operation
- If conservative treatment options have not yet been fully exhausted
- For complex medical cases with increased surgical risk
- If you want more certainty for your decision
- For young patients who have to expect several prosthesis changes
- Would you like to find out more about alternative surgical methods or prosthesis types?
- You have questions about different treatment approaches
Obtaining a second opinion does not delay the necessary treatment, but can prevent unnecessary or premature operations. Modern medicine relies on informed patient decisions based on comprehensive information and sufficient time for reflection.
Your legal right to a free second opinion
Since the end of 2020, the implantation of hip and knee endoprostheses has been included in the second opinion guideline of the Federal Joint Committee (G-BA). This regulation was adopted by the highest self-governing body in the German healthcare system and significantly strengthens your rights as a patient. Your attending physician is legally obliged to inform you of your right to a free second opinion at least ten days before the planned operation and to inform you accordingly.
The second opinion physicians bill their services directly to your health insurance company – there are no additional costs for you. This applies both to the initial implantation of a total endoprosthesis and to revision operations, prosthesis replacements or partial removals of hip and knee prostheses. The entire process is uncomplicated and free of charge for you.
Your steps to the second opinion procedure
- Information from your attending physician about the right to a second opinion
- Request for all relevant documents from your doctor
- Doctor search via the lists of the associations of statutory health insurance physicians
- Making an appointment with a qualified second opinion doctor
- Personal consultation with clinical examination
- Direct assumption of costs between doctor and health insurance company
For private patients: Fully insured private patients are generally also entitled to a second opinion. However, the exact conditions and the assumption of costs are regulated in your insurance contract. You should therefore contact your private health insurance company in advance and clarify the details of cost coverage.
You have the legal right to full access to your patient file and can request copies of all relevant findings, reports, laboratory values and imaging for the second opinion doctor.
Qualification and selection of the second opinion physician
Second opinion physicians require a special license from the Association of Statutory Health Insurance Physicians and must meet strict qualification requirements. The most important requirement is proven, long-term experience in endoprosthetics of hip and knee joints. They must be professionally and financially independent of the original treating physician and must not have shared a joint professional practice or employment in the last two years. This independence is crucial for an objective, neutral assessment of your case.
Qualified specialist groups for second opinions
- Orthopaedics and trauma surgery
- Special orthopaedic surgery
- Physical and rehabilitative medicine
- Surgery with a focus on trauma surgery
When making your choice, you should pay attention to the doctor’s specialization. Arthroplasty centers and specialized facilities often offer particularly qualified second opinions, as they have extensive expertise, modern diagnostic technologies and high case numbers. Doctors in certified arthroplasty centers usually have a great deal of experience with various surgical techniques and prosthesis models.
Where can you find qualified second opinion doctors?
- List of associations of statutory health insurance physicians: www.116117.de/de/zweitmeinung.php
- Patient service: Telephone number 116117
- Your health insurance company: support in finding a doctor in your region
- Websites of the German Society for Orthopaedics: Directories of certified centers
The associations of statutory health insurance physicians in the federal states maintain up-to-date directories and can provide you with targeted support in your search for a suitable specialist in your region.
Documents required for the second opinion interview
For a well-founded, comprehensive second opinion, the doctor needs complete information about your medical condition and previous treatment history. Careful documentation enables the second opinion doctor to make a precise assessment and avoid unnecessary repeat examinations. Your treating doctor must provide you with all relevant documents – you have a legal right to this.
Complete document checklist
- Doctor’s letter with diagnosis and detailed recommendation for surgery
- Imaging diagnostics: current X-ray images, MRI findings, CT images (ideally on CD-ROM)
- Laboratory values and other test results (e.g. inflammation markers)
- Course of treatment and documentation of previous therapy measures
- Reports on conservative treatments: Physiotherapy, injections, drug therapies
- Other relevant findings: reports from medical specialists or expert opinions
Practical tips for obtaining documents
- Ask for all documents to be handed over in good time
- Ask for complete copies of all findings, not just summaries
- Get imaging on CD for the best assessment quality
- Organize all documents for the interview in chronological order
- If it is incomplete, you can request additional information or supplement it from the second opinion doctor
Complete documentation is the basis for a high-quality consultation and helps the second opinion physician to assess all aspects of your case appropriately.
The second opinion procedure – step by step
The structured second opinion procedure follows a clear, comprehensible process that offers you certainty and transparency in the decision-making process. The entire process is designed to provide you with the best possible, independent advice and to take all relevant aspects of your case into account.
After making an appointment with a qualified second opinion doctor, a personal clinical examination is carried out first. This is essential, as a well-founded diagnosis is only possible through a physical examination in combination with the available findings. Telephone or video consultations are only permitted in justified exceptional cases.
After the second opinion consultation, you have complete freedom of choice. You can decide for or against the originally recommended operation, regardless of which recommendation the second opinion doctor makes. Neither doctor’s opinion is binding – the final decision lies solely with you as the patient.
Your options after the second opinion:
- Confirmation of the surgical recommendation: additional certainty for your decision to undergo surgery
- Alternative treatment: New treatment options that were not previously considered
- Further conservative therapy: avoidance of surgery in favor of non-surgical measures
- Time to think: more time for your decision without time pressure
If you have already made an appointment for an operation, you can cancel it at any time if the second opinion indicates other treatment options or if you decide against the operation. There is no obligation to implement a recommendation, even if both doctors agree to advise or advise against surgery. The second opinion helps you to make an informed, self-determined decision on the basis of comprehensive medical advice.
Indication assessment – when is a joint replacement really necessary?
The decision to undergo arthroplasty should be based on clear medical indications and should only be made after conservative treatment options have been carefully exhausted. A conscientious examination of indications protects you from unnecessary operations and their risks, while at the same time ensuring that you receive the best possible treatment for your complaints.
Clear indications for a joint replacement are advanced osteoarthritis with persistent, therapy-resistant pain that significantly impairs your quality of life. Severe movement restrictions that make everyday activities such as walking, climbing stairs or putting on shoes impossible also speak in favor of a surgical solution. Night-time pain at rest that deprives you of sleep and a significant reduction in quality of life despite conservative treatment can support the indication for surgery.
Important factors in determining the indication
- Extent of personal suffering and pain intensity
- Functional limitations at work, in everyday life and with hobbies
- Quality of life and individual mobility requirements
- Age and life expectancy of the patient
- Concomitant diseases and surgical risk
- Imaging findings in correlation with the symptoms
- Exhaustion of conservative treatments over a sufficient period of time
A critical review is necessary if the symptoms are not yet pronounced enough or conservative treatment options have not been fully exhausted. Premature surgery for minor symptoms or inadequate conservative treatment should be avoided as it carries the risk of unnecessary complications and may not produce the desired results.
Warning signals for a potentially premature surgical recommendation
- Insufficient information about alternative treatment options
- Lack of time to think or pressure to make a quick decision
- Purely imaging-based surgical recommendation without correlation to symptoms
- Conservative therapies not exhausted
- Exaggerated promises regarding the success of the operation
A serious, patient-oriented consultation always takes your personal situation into account, offers sufficient time for your decision and presents all treatment options transparently.
Quality features for the right choice of clinic
Choosing the right clinic has a significant influence on the success of your arthroplasty operation, the complication rate and your long-term satisfaction with the procedure. Certified arthroplasty centers (EPCs) have been proven to offer the highest quality standards and must meet strict requirements in terms of equipment, staff qualifications and treatment results. These centers are subject to regular external quality controls by professional associations.
Key quality criteria are high annual case numbers and the specialized experience of the surgeons. Surgeons who implant endoprostheses regularly and in large numbers have statistically lower complication rates and better functional results. Modern minimally invasive surgical techniques and muscle-sparing procedures enable faster healing, less post-operative discomfort and better cosmetic results.
Structured fast-track concepts ensure optimized treatment from admission to discharge
- Preoperative patient training and comprehensive preparation for the procedure
- Standardized surgical procedures and proven aftercare protocols
- Early mobilization just a few hours after the procedure
- Interdisciplinary cooperation between all professional groups involved
- Structured pain therapy and thrombosis prophylaxis
- Plannable discharge after a short but safe stay
Important selection criteria for your clinic
- EPC certification from the German Society for Orthopaedics and Trauma Surgery
- High annual case numbers for hip and knee prostheses (>100 per year)
- Use of modern surgical procedures and high-quality implants
- Transparent communication about success and complication rates
- Specialized aftercare and rehabilitation concepts
- 24/7 availability for emergencies and complications
Alternative treatment options before the operation
Before any joint replacement, conservative treatment options should be systematically exhausted over an appropriate period of time. In many cases, these non-surgical treatment options can bring about a significant improvement in symptoms, delay surgery or even make it unnecessary in certain cases. A well-founded second opinion can provide valuable impetus as to which of these options have not yet been used or have not been used sufficiently in your case.
Physiotherapy and physiotherapy are at the heart of conservative treatment. Targeted training strengthens the joint-stabilizing muscles, improves mobility and can reduce pain through better biomechanics. Drug-based pain therapy with anti-inflammatory drugs (NSAIDs) can provide significant relief for acute pain and inflammation, but should be used for a limited period of time.
Proven conservative therapy methods
- Joint injections: Hyaluronic acid injections or cortisone directly into the joint to reduce pain
- Autologous blood therapy (PRP treatment): Use of the body’s own growth factors for regeneration
- Shock wave therapy: non-invasive pain therapy to improve circulation
- Acupuncture: Complementary treatment for pain relief
- Radiofrequency therapy: for chronic pain for nerve blockade
- Physical therapies: Electrotherapy, ultrasound or heat applications
Lifestyle adjustments play a key role in joint health. Weight reduction in the case of obesity relieves the joints considerably – every kilo less body weight reduces the strain on the hip and knee joints many times over. Joint-friendly sports such as swimming, cycling or aqua fitness keep you mobile without putting excessive strain on your joints.
Tools and support
- Orthopaedic insoles for correcting and relieving the strain on the ankle
- Bandages or orthoses for additional stability
- Crutches or forearm supports for relief in everyday life
- Ergonomic adaptations in the living and working area
The combination of various conservative approaches over a sufficiently long period (usually 3-6 months) should be carried out consistently before deciding on surgery.
Frequently asked questions (FAQ)
As a patient with health insurance, can I get a second opinion on a joint replacement?
Yes, absolutely. Since the end of 2020, as a person with statutory health insurance, you have been legally entitled to a free second opinion for planned hip and knee endoprosthesis operations. The costs are fully covered by your health insurance if you consult a qualified, licensed second opinion doctor. Your treating doctor is even legally obliged to inform you of this right at least ten days before the planned operation. Billing takes place directly between the second opinion doctor and your health insurance company, so that there is no financial burden for you.
When is a second opinion particularly useful?
A second opinion is particularly valuable if you are uncertain about the need for surgery, if you have doubts about the urgency of the procedure or if you would like more certainty in your decision. A second opinion can also provide important additional information if conservative therapies have not yet been fully exhausted or in complex medical cases with an increased surgical risk. An independent assessment is particularly recommended for young patients who are expecting several prosthesis replacements or if you would like to find out more about alternative treatment methods.
How do I find a qualified second opinion doctor?
The easiest way to find qualified second opinion doctors approved by the Associations of Statutory Health Insurance Physicians is to use the official list at www.116117.de/de/zweitmeinung.php or by contacting Patient Services on 116117. Your health insurance company can also help you find a suitable doctor in your region and often offers a special consultation service. Make sure that the doctor has a valid license as a second opinion doctor and is independent of the doctor who originally treated you.
What happens if both doctors give different recommendations?
Differing recommendations are not unusual and are initially no cause for concern. They often reveal different treatment philosophies or different weightings of risks and benefits. See this as an opportunity: you now have a broader, more well-founded information base for your decision. The final decision is always up to you as the patient – you are not bound by either of the two medical recommendations. Use the different perspectives to make the best decision for your personal situation and your life goals.
Does a second opinion delay the necessary treatment?
No, a second opinion does not delay urgent medical treatment. Joint replacement operations are usually elective, plannable procedures that do not have to be performed as an emergency. The few days or weeks for a second opinion have no negative impact on the outcome of the operation, but can prevent you from undergoing unnecessary or premature surgery. In genuine emergencies, your doctor would not refer you to a second opinion anyway.
Do I have to tell my first doctor about the second opinion?
There is no obligation to inform your original practitioner that you are seeking a second opinion. However, many patients find it respectful and transparent to communicate this. Reputable doctors will understand and support your desire for a second opinion as it is the standard of good medical practice. If you feel uncomfortable, you can also seek a second opinion discreetly.
Conclusion – Your health, your decision
The second opinion procedure for hip and knee replacements is more than just a legal right – it is an important component of modern, patient-oriented medicine. It strengthens your position as a patient and enables you to make an informed, self-determined decision about one of the most important medical procedures of your life. Take advantage of this valuable right to comprehensive information, independent advice and sufficient time to think things over.
A critical assessment of the indications by an independent specialist contributes to responsible medicine and can prevent unnecessary operations. At the same time, a confirming second opinion gives you additional security and confidence in your decision to undergo surgery. Both scenarios are valuable for your health and well-being.
Your way to a second opinion
- Actively use your legal right to free advice
- Collect all relevant documents for a well-founded assessment
- Choose a qualified, independent second opinion doctor carefully
- Ask all the questions that are important to you
- Make your decision on the basis of comprehensive information
Do not hesitate to make use of your right to a free second opinion. Talk to your doctor about the second opinion procedure or contact your health insurance company directly for support in finding a doctor. Your health and quality of life deserve the best possible medical advice and a decision that you can make with a clear conscience and full conviction.
An informed patient decision is the basis for the best possible treatment success and your long-term satisfaction with the chosen therapy.
Part of Ortivity Network
