The University of Southampton

Category: Rehab and prostheses

A Joint Effort: NHS or Private – What’s the Right Option?

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Audio transcript:

The lecture series by Prof Dickinson on prosthetic joints prompted my thoughts on this topic with my tennis interest in Andy Murray and how it has affected close family friends.

The comeback of Murray following his hip resurfacing was astounding. Watching him win the European Open tournament in Belgium post-surgery demonstrated his determination and ability to compete at the highest level.

Andy Murray
An image of Andy Murray playing at the 2012 US Open. Available at https://commons.wikimedia.org/wiki/File:Andy_Murray_(US_Open_2012).jpeg (Accessed: 14/03/2025). By Francisco Diez, licensed under the Creative Commons Attribution 2.0 Generic license from Wikimedia Commons.

Murray’s hip resurfacing was done privately and quickly. I will share two stories from close family friends who have had very different experiences on knee replacements.

What is a knee replacement?

This topic is explained here. The summary is that knee replacements are used to treat pain and stiffness in the joint, usually caused by osteoarthritis. The process involves making an incision in the knee with metal and plastic replacement parts fitted as seen in the image below.

Total knee replacement image
An image of the components for a total knee replacement. Available at https://commons.wikimedia.org/wiki/File:Knee_Replacement.png (Accessed: 14/02/2025). By BruceBlaus, licensed under the Creative Commons Attribution-Share Alike 4.0 International license from Wikimedia Commons.

How successful are knee replacements?

A 2020 NHS report found that from over 80,000 patients, 75% responded that they felt much better following the operation with 64% being very satisfied with the results. The success of this treatment is why I feel access to them is so important, but the question of how to make it fair is challenging.

Wait times

The NHS has a very open website called My Planned Care. Taking the University Hospital Southampton statistics accessed on 21/03/2025, in the orthopaedic department the average wait time for treatment was 21 weeks. This led me to read a journal article “Who should have priority for a knee joint replacement?”. The degree of suffering, payment of National Insurance and caring for dependants are reported as the most important factors.

My friends

Ms D went down the private route for her knee replacement and had the operation within three weeks. Before this time, she had put on weight and was withdrawn socially. After the operation, Ms D’s mobility improved, and she resumed frequent international travels.

Ms C suffers from severe knee pain such that she rarely travels far on foot, something that has dampened her usually bubbly spirits. Ms C is opposed to private treatment. She also has a close friend who had a private knee replacement that was infected. Ms C is on an NHS waiting list for knee replacements and is hoping to have the operation in the next few months.

My dilemma

Both people have very different outlooks. My main concern is regarding quality of life. Ms D has now sadly passed away, but she lived ten years with her knee replacement. Ms C is in her late seventies and suffers. I tried to put it to Ms C’s husband in a recent phone call about “Why don’t you consider the private option?”, but it was quickly shot down. If it could be afforded, then the quality of life improvement would be massive, surely it would be worth the money?

Concluding thoughts

Having been a medical student for a couple of years before switching university courses, I have seen first-hand how the NHS system is struggling. I often have a pessimistic view on its survivability in its current form and I see private healthcare as a necessary evil.

Knowing that both suffered greatly, with Ms D having a huge quality of life improvement, makes me uncomfortable with the fact that this could’ve been avoided in Ms C’s case. I find myself feeling regret that Ms C hasn’t put her morals aside for the benefit of her physical and mental wellbeing.

The video below summarises my debate

Poo in a bag?!

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When we talk about prostheses, most of us think of prosthetic legs and arms like those we see used by Paralympic athletes. I was interested to learn from Prof Alex Dickinson’s lecture that the definition of a prosthesis is much broader, encompassing any artificial replacement body part.

Anatomy of an end colostomy, where the end of the colon, as well as the rectum and anus, have been removed.1

Stomas and ostomy bags technically come under this definition, but see far less media attention. A stoma is a hole made in the abdomen during surgery, through which to divert faeces (or urine, but I’m not going to cover that here). The surgery is called a colostomy or ileostomy, depending on whether it is part of the large or small intestine that is diverted through the stoma, and the piece of bowel empties into an ostomy bag, which is affixed to the outside of the body.

A stoma may be temporary or permanent, depending on the type of surgery and the reason it is needed. According to the NHS2, a person may need to have part of their bowel removed due to a tumour, infection or inflammatory bowel disease (IBD) such as Crohn’s disease or Ulcerative Colitis. Temporary stomas may be needed to give the bowel the opportunity to rest after surgery, or if there has been an injury to the bowel, and may be reversed later. These interventions can be life-changing for the people undergoing them, who are often living with severe pain, digestive issues and sometimes incontinence prior to surgery. Sometimes stoma surgery is the only option to save a person’s life.

When K, a close friend of mine, first told me about her stoma I had never even heard of the word. I don’t think I was alone in my ignorance. According to Colostomy UK3, one in 335 people in the UK live with a stoma, so why are they so rarely talked about?

Social stigma around our bodily functions (especially the smelly ones!) means that this area of medicine is shrouded in mystery for most ordinary people. Nobody wants to talk about their poo, and discussions of bowel disease are a step too far for many a mild-mannered Brit. I am absolutely in support of keeping bodily fluid talk to a minimum at the dinner table, but what about in wider discussion? These things need to be talked about.

According to Crohn’s & Colitis UK4, people living with IBD can often experience feelings of shame and isolation as a result of their disease. Stomas are widely misunderstood; K tells me that hers has enabled her to regain the freedom to live a normal life, but she still faces social stigma, even from the nurses that she works with. It can be hard dealing with people’s misconceptions at the same time as trying to navigate life with a chronic illness.

Negative conversation about bowel disease and stomas, a reality for so many people, can have a real detrimental effect on their self-esteem. It can also be a barrier to meeting needs in the workplace, such as access to a disabled toilet, or accommodations for symptoms.

A more open discussion is needed around bowel disease, stomas and invisible illnesses, so that people like K can have the confidence and resources to access the support they need to live a healthy and fulfilling life. Crohn’s & Colitis UK’s Are You IN? 5 campaign aims to start the conversation by educating employers and employees about invisible illnesses such as IBD. Everyone can play their part by being mindful about how we talk about these conditions, recognising that what might seem strange to us is another person’s reality.

K consented to the information shared here, and her initial has been changed to protect her privacy.

Sources

  1. MacMillan Cancer Support (2025). What is a stoma? (accessed 04/03/25). Available at https://www.macmillan.org.uk/cancer-information-and-support/bowel-cancer/what-is-a-stoma ↩︎
  2. NHS (2024). Health A-Z, Colostomy (accessed 04/03/25). Available at https://www.nhs.uk/conditions/colostomy/ ↩︎
  3. Colostomy UK (2025). What is a stoma? (accessed 04/03/25). Available at https://www.colostomyuk.org/information/what-is-a-stoma/ ↩︎
  4. Crohn’s & Colitis UK (2025). Mental health and wellbeing (accessed 04/03/25). Available at https://crohnsandcolitis.org.uk/info-support/information-about-crohns-and-colitis/all-information-about-crohns-and-colitis/living-with-crohns-or-colitis/mental-health-and-wellbeing ↩︎
  5. Crohn’s & Colitis UK (2025). Are you IN? (accessed 04/03/25). Available at https://crohnsandcolitis.org.uk/our-work/campaigns/are-you-in?_gl=1*1w75irk*_up*MQ..*_ga*Njg1NjMyNDE0LjE3NDA4NDM1NzU.*_ga_5THF1XE73Q*MTc0MDg0MzU3NC4xLjEuMTc0MDg0Mzc2My4wLjAuMA.. ↩︎