Knee replacement surgery

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statsguy
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Knee replacement surgery

Post by statsguy »

So what do you guys and gals know about knee replacement surgery. I finally have decided to do it next June.

Right now I am trying to decide if my local doctor should do it (my co-pay would be about $4000) or if I should pay $20000+ and have Dr. Raj (voted best knee and hip replacement doctor in US) do it.

Looking for comments
Stats
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Fletch
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Re: Knee replacement surgery

Post by Fletch »

Per my wife who had TKR about 1.5 years ago:

1. Pick a doctor who had done hundreds, if not thousands, of knees.
2. Talk to some of the doctor's patients to see what they think and if they are satisfied.
3. Find out doctor's 5 or 10 year success rate (patients with no problems) if possible.
4. Find out doctor's (or hospital) mortality rate for the procedure you are having.
5. Find out the doctor's (or hospital) infection rate for all types of surgeries.
6. Be sure to do the proscribed leg strengthening exercises well in advance, makes a huge difference in the recovery process ... start now.
7. Find a good physical therapist who will "work you until you hate him" during the recovery process. Will be Hell for a month, then you will be glad you did it. It will take you approximately one year before you are "close to normal" again.
8. Money, if you can afford it, should be the last consideration after you do all the above.

PM me if you have specific questions. Best wishes for a successful surgery.

... Fletch
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G12
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Re: Knee replacement surgery

Post by G12 »

My wife is a physical therapist who has worked with a ton of ortho/knee rehab patients, most have very good recoveries even at advanced ages. Our neighbor across the street became one of her patients and this guy was, at minimum, 100 lbs overweight partially due to his bad knee. He is mid-50's and had an excellent outcome, has lost about 50 lbs and walks normally these days without any indication of a knee issue. He said he considered himself fortunate because his own doctor was going to have knee replacement surgery within 6-months and recommended him to the surgeon that was going to do his. The ortho doctor is a high volume guy that has done thousands of procedures. The neighbor also said research specific replacement devices, one may be better for your specific scenario/frame/body than another. Good luck.
Van
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Re: Knee replacement surgery

Post by Van »

I had a partial knee replacement in November of 2009. Other recent surgeries: back (spinal stenosis) Sept. 2009; elbow (ruptured tendon) Jan. 2010; back (L4-5 fusion) June 2011. The knee was by far the most painful, both during the postop period and during rehab. I do not tell you this to discourage you in any way. I just want you to know that it won't be "a piece of cake". Unfortunately, my surgeon did not prepare me for what was coming after the surgery. My outcome was good, and I walk pain-free now except for the rare occasion when I overdo it (e.g. walking >5 miles for several consecutive days).

As mentioned by a previous poster, it is essential to strengthen your leg muscles (especially the quads) prior to the surgery. Also, the first 30 days or so after surgery are critical for getting a good range of motion back in your knee. Push it hard. It will hurt, but you are only going to get one opportunity to get it right.

GOOD LUCK.
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plannerman
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Re: Knee replacement surgery

Post by plannerman »

My wife had a total knee replacement last April with great results. She had the procedure done in a brand new 36-bed voluntary surgical hospital. No ICU, no emergency room, no sick people. If you want to avoid a hospital infection, you need to pay as much attention to selecting the facility as you pay to selecting the doctor.

plannerman
beareconomy
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Re: Knee replacement surgery

Post by beareconomy »

If I were you, if you happen to know a few docs, you could ask them who the best guy is to go to. You want to go to someone who does at least 500 of these / year. Don't go to the guy who only does 30. Experience and skill matter in medicine. Just my 2 cents.
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Bengineer
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Re: Knee replacement surgery

Post by Bengineer »

When it gets to that point, check out the prosthetic chosen for you. Does it have a track record of years of good outcomes for your demographic (ht, wt, age, ethnicity, activity?) Think long and hard if it is "the latest and greatest" just out.
Sam I Am
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Re: Knee replacement surgery

Post by Sam I Am »

Our neighbor has had a knee and a shoulder replacement, and both surgeries had excellent results. Her mother had both knees replaced with very good results. Her mother was overweight, but still was able to rehab and enjoy relief from pain.

My health care aide has had a hip replaced, and will have her other hip replaced soon. Good result for her as well. Once she rehabbed she returned to work for all her clients. She is halfway there, one hip down, one to go.

The key to the successes is just what others have said before me, do your therapy as instructed. Don't cheat, do it all as ordered.

All those I have talked to are so happy they had their replacements done, they were able to do normal activities with virtually no pain, and have progressively become more confidant using their new joints.

Sam I Am
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statsguy
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Re: Knee replacement surgery

Post by statsguy »

Thanks for the information so far

Here is some more information. I am 57 and have a type of arthritis that eats away my cartilage. My left knee has 1 millimeter of cartilage and my orthodpedic says he will do the knee replacement anytime that I want but that because I am so young he recommends waiting as long as possible. Anyway I can no longer walk up stairs without taking them one stair at a time with my good knee/leg and walking on uneven ground is becoming more difficult.

My orthodpedic is very good but has only done about 100 of these surgeries while this Dr. Raj (drhipandknee.com) is nearby though much more costly for me. I found him because he was voted by his peers as the top orthopedic for hip and knees in the US last year. I have always heard that you should go to the guy who has done the most surgeries and this guy has done a bunch the last few years.

Thanks, keep the comments coming.
Stats

PS I have heard how painful this surgery is and that it will be at least three months before I am hobbling again. My hope is to do the surgery in June when I have six months off work to rehabilitate.
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Frobie
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Re: Knee replacement surgery

Post by Frobie »

Fletch wrote: 7. Find a good physical therapist who will "work you until you hate him" during the recovery process. Will be Hell for a month, then you will be glad you did it. It will take you approximately one year before you are "close to normal" again.
Two of the funnier things I've heard people in health care say over the years include this (routinely used by one of the geriatrics attendings I work with, and not just to ortho patients--but I think his exact phrase is, "If you don't hate your physical therapist, you need to find a new one").

The other is the dietitian I used to know who (at least claims she) told patients, "If it tastes good, spit it out."
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G12
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Re: Knee replacement surgery

Post by G12 »

PS I have heard how painful this surgery is and that it will be at least three months before I am hobbling again. My hope is to do the surgery in June when I have six months off work to rehabilitate.
Just spoke with my wife, she said if you are in significant pain you should have the surgery as soon as you feel comfortable with your decision, many of her patients wish they had done it sooner. In the meantime do as much strenthening as you can handle. She said the pain depends on your tolerance and outlook, but mean are more whiny than women---truth. Buck up, man. :D She said if you can handle the therapy you should be using a cane for 3-weeks, then gain more mobility/range of motion/strength and feel pretty normal w/i 6-months. She strongly suggested speaking to the PT's that handle the high volume guy's patients to get their thoughts/patient rehab times/results. Good luck, I might be in the same boat in 6-10 years on the left knee.
stan1
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Re: Knee replacement surgery

Post by stan1 »

If it was me:

I wouldn't worry too much about ratings that may be a popularity contest or be impressed by a surgeon with an office in Beverly Hills. The surgeon with the best marketing consultant who gets him into a Top 10 list and a slick website might not be the best surgeon. I'd look for someone who does 300-500+ surgeries per year specializing in knees, is someone your primary care physician recommends, and is also covered by your insurance.
Last edited by stan1 on Wed Dec 14, 2011 8:28 pm, edited 1 time in total.
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jw424
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Re: Knee replacement surgery

Post by jw424 »

Statsguy,

I am one of the lucky ones. Am 71 years old and was bone on bone in both knees. Am 260 lbs.

Prepared by doing four weeks of leg exercises as suggested by doctor. Had right knee done in Sept 2010. Left knee done in April 2011.

Dr used a front and back nerve block for each surgery. (New method?) Knee block allowed in house bending (110 degrees) same day as surgery with no pain but could not stand unassisted the first day and one half. Could have walked out of hospital after three days. Played 18 holes of golf eight weeks later.

Second knee went even better walked unassisted after five days. (Did carry cane for safety) Again played golf in eight weeks. Could have played sooner but waited for release from doctor.

No need for the best but do as others suggested. MY doctor does 400 per year and the hospital does 2400 per year. (Spectrum in Grand Rapids Michigan) Do your pre surgery exercises and the after surgery exercises and you will do well.
Rubiosa
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Re: Knee replacement surgery

Post by Rubiosa »

Any thoughts on doing both knees at the same time? Impossible?
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Re: Knee replacement surgery

Post by magician »

I have no first-hand experience, but do have second-hand experience: a magician whom I know and an economist whom I know have both have had knee replacements: the former is in his 80s and the latter in his 70s. They're both exceptionally pleased with the results.

I've had both ACLs replaced with cadaver grafts and couldn't be happier.

If knee replacement surgery were the only option I had, I'd do it in a minute.
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Ozonewanderer
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Re: Knee replacement surgery

Post by Ozonewanderer »

stan1 wrote:If it was me:

I wouldn't worry too much about ratings that may be a popularity contest or be impressed by a surgeon with an office in Beverly Hills. The surgeon with the best marketing consultant who gets him into a Top 10 list and a slick website might not be the best surgeon. I'd look for someone who does 300-500+ surgeries per year specializing in knees, is someone your primary care physician recommends, and is also covered by your insurance.
+1.
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NateH
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Re: Knee replacement surgery

Post by NateH »

My mother had her knee replaced 10 years ago in her late fifties. She must have figured it was like taking a pill and she'd be better. She didn't do all (any?) of the pre-strengthening work and didn't push herself during post-op therapy. never did the excersizes at home, that i could tell. Certainly, she didn't do them past the point of discomfort.

I had my ACL replaced years ago, so i told her the therapy was key---she didn't listen.

She has maybe 80% range of motion and limps today like she did before the replacement. That she has gained weight because she doesn't like to walk anywhere + favoring her 'good' knee is making the 'good' knee wear out now, too.
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magician
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Re: Knee replacement surgery

Post by magician »

NateH wrote:I had my ACL replaced years ago, so i told her the therapy was key . . . .
Amen!

After my first ACL replacement I was told I would be on crutches for 6 weeks and in physical therapy for 6 months. I was off the crutches in two weeks and out of PT in two months, because they told me that there wasn't anything more they could do for me. While in PT, if they told me to do 10 reps of a given exercise, I did 20. If they said do 50, I did 100. If they said 5 minutes, I did 10. A gentleman who was there after back surgery (and who whined about every exercise they told him to do) asked me why I was working so hard.

"Do you like being here?"

"No, I hate it."

"So do I. So I'm working as hard as I can to get out of here as quickly as possible."

On my last visit to the therapist they did a number of tests to compare my injured knee (left) to my good knee. In every test my left knee/leg outperformed my right. They finally found a test at which my right leg outperformed my left: a fatigue test ("Do a leg extension and push until you can't push any more.")

When you go to physical therapy, ask yourself if you enjoy being there. If not, then work as hard as you can (as hard as they tell you to work) to build your strength and range of motion; the harder you work, the quicker you'll be out of PT (and the better off you'll be afterward).

Best of luck!
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Re: Knee replacement surgery

Post by greenspam »

statsguy wrote: My orthodpedic is very good but has only done about 100 of these surgeries while this Dr. Raj (drhipandknee.com) is nearby though much more costly for me. I found him because he was voted by his peers as the top orthopedic for hip and knees in the US last year. I have always heard that you should go to the guy who has done the most surgeries and this guy has done a bunch the last few years.
He was NOT voted by his peers as the top orthopedic for hip and knees in the US last year...

but, if you look into the details of his very slick website http://www.drhipandknee.com/ , you will see that:

He WAS named one of "America's Top Orthopedists" by the Consumers' Research Council of America, a bogus organization that charges doctors and other professionals money in exchange for a plaque and to get mentioned in their book; see:
http://www.forbes.com/2009/05/02/americ ... uncil.html

He WAS also recognized as a 2012 Southern California "Super Doctor", to be published in the January 2012 issue of Los Angeles magazine. the 'Super doctors' are selected by an organization called key professional media. about 5% or 1 of 20 doctors in any given region in any given specialty are given this 'honor'. see:
http://www.superdoctors.com/about/selec ... ocess.html

and, he WAS named a "Top Doc America 2011", meaning he advertises in this website:
http://www.topdocla.com/

you all can be the judge of these accolades.... :beer
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Offshore
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Re: Knee replacement surgery

Post by Offshore »

Greenspam hit the bullseye with his research and comments.
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Re: Knee replacement surgery

Post by rallycobra »

Find out the infection rate for knee replacements at the hospital they do the surgery at.
See if they get you walking the same day of surgery. The faster you get up and start rehab the better!
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Re: Knee replacement surgery

Post by scylla »

If you can find a doc at the Hospital for Special Surgery in New York City, that's where I'd go. Rated tops in Orthopedics. I had my hip done there four years ago. Went like clockwork. The bonus is, because the hospital is purely orthopedics, there are very few "sick" patients, which greatly lessens your chance of hospital-caused infection.
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Re: Knee replacement surgery

Post by greenspam »

HSS in NYC would be a long way to travel from LA..... perhaps try USC or UCLA medical schools
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magician
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Re: Knee replacement surgery

Post by magician »

If you're looking for someone in or near Los Angeles, look up Dr. Joseph Mayo (yes, he's one of those Mayos) in Placentia. I don't know if he does knee replacements, but if not I'm sure he'll give you an excellent referral.
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Larry Johnson
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Re: Knee replacement surgery

Post by Larry Johnson »

Something missed by all of you is pivotal concerning knee and hip replacements. There are two types: PMA and 510k. 510k devices are experimental, and it is a felony for a manufacturer to represent they are safe. PMA ( pre-marked approved) costs hundreds of thousands of dollars to get on the market. 510k devices only require a showing the new device is substantially similar to a PMA device.510k devices are responsible for the plethora of lawsuits because of early failures. I pioneered a lawsuit over these types of devices. My expert from Cornell Hospital for Special Surgery quipped to me: "you know these manufacturers are gangsters don't you." I thought this hyperbole until I started digging into their records, AND THEY ARE. One company discovered their hip implants were having massive failures and tried to improve them by nitrogen ion bombardment. They advertised to their distributors the new device was 1000 times more wear resistent, but told they to sell off the 33,000 units in inventory first before selling the new ones. Acetabular components made of ulta high molecular weight pollyethylene were causing massive wear particles. The five components I had tested were all contaminated with sand, and one had a 1 cm long wire embedded. All I can tell you is BEWARE because most doctors either don't know the difference or they are getting a royalty by selling this crap.
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magician
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Re: Knee replacement surgery

Post by magician »

Larry Johnson wrote:Something missed by all of you is . . . or they are getting a royalty by selling this crap.
Wowzer!

Thanks for adding this important caveat.
Simplify the complicated side; don't complify the simplicated side.
trico
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Re: Knee replacement surgery

Post by trico »

This last article kills me. We can send our people to the Moon, and now maybe Mars. We can put a Rover on Mars, but we can't even make a knee replacment device. Americans need to fire Congress and take over where the way these funds are spent.
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greenspam
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Re: Knee replacement surgery

Post by greenspam »

Larry Johnson wrote:Something missed by all of you is pivotal concerning knee and hip replacements. There are two types: PMA and 510k. 510k devices are experimental, and it is a felony for a manufacturer to represent they are safe. PMA ( pre-marked approved) costs hundreds of thousands of dollars to get on the market. 510k devices only require a showing the new device is substantially similar to a PMA device.510k devices are responsible for the plethora of lawsuits because of early failures.
510(k) devices are not "experimental", they are devices approved for by the FDA via the 510(k) approval process, as opposed to the much more costly and time consuming PMA (Pre-Market Application) process. And it takes millions to tens of millions of dollars, not hundreds of htousands of dollars, to run clinical trials for a PMA and get a new device on the market...

So, 510(k) is quicker, cheaper, and these companies are in business to make money..... so which route do you think they choose ??? In one study (time period 1976 - 1995), the vast majority of total hip replacement devices (95%) were approved by the 510(k) process, not the PMA process, see:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2577946/

But, that door is closing....recently, the 510(k) approval route has come under fire, and there are major changes underway, based in part on recommendations of an independent study by the Institute of Medicine, see:
http://www.iom.edu/~/media/Files/Report ... 0Brief.pdf

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rokidtoo
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Re: Knee replacement surgery

Post by rokidtoo »

I had my hip replaced by Dr. Hamilton at the Anderson Orthhopaedic Clinic in Arlington, VA in 2009. I experienced a quick recovery and have been totally satisfied with the results. According to my wife, who is an R.N., they're the best in the Washington, DC region.

Anyway, the link below is to their web site. The site contains information about knee replacement options and citations to publications produced by the clinic's physicians. Hopefully, the information helps in your decision making process. Good luck.-----Jim

http://www.andersonclinic.com/about/
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statsguy
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Re: Knee replacement surgery

Post by statsguy »

Thanks Greenspam for the research... I had already figured out that his laurels were likely paid for.

Thanks to all those who gave their experiences with joint replacement.

As everyone says doing physical therapy honestly is key. I have already had three surgeries to repair my shoulders and two on my knees. This will be my first joint replacement. My doctor is concerned that at 57 I will wear the joint out and have to repeat the process... so he has encouraged me to wait as long as possible. I have waited five years and while the pain is not great the knee is no longer stable. I am concerned I am creating other problems by waiting. Because of my arthritic condition I am at risk of needing my hips replaced too.

After researching doctors more, I have found one I think I am comfortable with. I don't know how many surgeries he has done or his success rate but he comes highly recommended and is associated with Cedar Sinai Medical Center in Los Angeles, which has a highly regarded joint replacement program. Is there some way to get this kind of information online? My plan is to make an appointment and see if I am comfortable with him. Will also interview some of his previous patients (if possible) and talk to the caregivers where he has patients do physical therapy.

Thanks again to everyone who replied. I would welcome more information.
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Cb
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Re: Knee replacement surgery

Post by Cb »

statsguy wrote:...Thanks again to everyone who replied. I would welcome more information.
I'm 52 and get Synvisc injections every 6 months trying to delay TKR until I'm 60 or so.

I found this series of Youtubes fascinating - these are the lectures from a UC-Berkely graduate bio-engineering course on the design & materials challenges facing artificial joint manufacturers:

http://www.youtube.com/watch?v=I5YSTkBQBbs

Here's another Youtube on hip & knee replacement I found fascinating, by a very high volume doc at a high-volume facitility - UCSF, I believe

http://www.youtube.com/watch?v=Fsszk2iNAqg

Cb
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Dan Moroboshi
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Re: Knee replacement surgery

Post by Dan Moroboshi »

greenspam wrote:
statsguy wrote: My orthodpedic is very good but has only done about 100 of these surgeries while this Dr. Raj (drhipandknee.com) is nearby though much more costly for me. I found him because he was voted by his peers as the top orthopedic for hip and knees in the US last year. I have always heard that you should go to the guy who has done the most surgeries and this guy has done a bunch the last few years.
He was NOT voted by his peers as the top orthopedic for hip and knees in the US last year...

but, if you look into the details of his very slick website http://www.drhipandknee.com/ , you will see that:

He WAS named one of "America's Top Orthopedists" by the Consumers' Research Council of America, a bogus organization that charges doctors and other professionals money in exchange for a plaque and to get mentioned in their book; see:
http://www.forbes.com/2009/05/02/americ ... uncil.html

He WAS also recognized as a 2012 Southern California "Super Doctor", to be published in the January 2012 issue of Los Angeles magazine. the 'Super doctors' are selected by an organization called key professional media. about 5% or 1 of 20 doctors in any given region in any given specialty are given this 'honor'. see:
http://www.superdoctors.com/about/selec ... ocess.html

and, he WAS named a "Top Doc America 2011", meaning he advertises in this website:
http://www.topdocla.com/

you all can be the judge of these accolades.... :beer
:peace
This picture on the website is amusing

Image

No, not the scrub shirt that shows off his impressive guns. That's sooo stereotypical.

I don't know any orthopaedic surgeons who would wear a stethoscope around their neck like that. In fact, surgeons have been known to call that a "flea collar".

But back to the original topic...

A hundred joint replacements sounds like a lot, but I would be more comfortable with someone who's done a lot more. Several hundred at least. Why? My dad, a retired surgeon, was fond of the old joke, "Good doctors have good judgement. Good judgement comes from experience. Experience comes from prior bad judgement."

Somebody who's done many, many procedures has had an opportunity to experience some of the rarer complications. You get to benefit from the misfortunes of prior patients. That's not to say that experience guarantees a good outcome. Medicine is complex, and there are factors that can be controlled with preparation and technique, and factors that are uncontrollable. But all other factors being equal, surgeons (like anyone else) tend to be good at what they do frequently, and the more experienced your surgeon is, the better.

Someone else mentioned looking up hospital complication rates. Some states post hospitals' data online (e.g. Pennsylvania). The data are a rough metric, but if a hospital has consistently above average complication rates, you may want to think twice about having elective surgery there.

If you have the opportunity to corral a physical therapist, a nurse or surgical tech who works in the OR, or a nurse who works on the inpatient orthopaedic unit, ask them who they would recommend to do your knee replacement. Those folks are in a position to see more than one surgeon at work, or the results of their work. They may hesitate to tell you who is the "best", but they'll usually be forthcoming about who shouldn't do your surgery. If you tell them who's doing your surgery and they say something like "Hmmmmm. You know, it wouldn't hurt to get a second opinion" or the like, TAKE THE HINT.

(Disclaimer: I am an orthopaedic surgeon. I no longer try to show off my guns. I haven't worn a flea collar since internship. I'm not even sure which end of the stethoscope I'm supposed to listen to any more.)
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greenspam
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Re: Knee replacement surgery

Post by greenspam »

a few more things....

1) the DECISION is more important than the INCISION. are you absolutely sure you need surgery ??? have you gotten a second opinion, and exhausted non-operative options such as painkillers or HA injections etc...

2) would recommend an academic medical center, aka a teaching hospital, as opposed to a community hospital. in addition to performing a large volume of cases, most academicians publish papers and train residents, so they are up to date with the latest research and clinical trials etc...

3) reiterating, as others pointed out, that the choice of implant type/manufacturer, and sticking to the rehab protocol, are equally critical as the choice of surgeon

4) remember to take a 'sharpie' marker and write "NO" on the non-operative limb, and "YES" on the limb which requires surgery.

good luck
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schulmje
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Re: Knee replacement surgery

Post by schulmje »

I am an orthopedist, I work in DC, have no connections to any west coast ortho docs. If you are in LA, Larry Dorr is a nationally well respected joint replacement specialist. I have never personally met him, but his reputation precedes him
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Re: Knee replacement surgery

Post by magician »

greenspam wrote:4) remember to take a 'sharpie' marker and write "NO" on the non-operative limb, and "YES" on the limb which requires surgery.
When I had my first ACL replaced (my left), the surgeon came in to see me before the operation, read my chart, and said, "Left knee. That's this one," pointing to my right knee.

(Yes, he was kidding.)

When I had my second ACL replaced (my right), on my left knee I wrote, with a Marks-a-Lot marker, "NOT THIS KNEE". The surgeon (not the same one) was not amused. My GP, who assisted in the surgery, thought it was hilarious.

My wife used to work in a health system. When the head of risk management had ankle surgery, the surgeon discovered that she'd taken several colors of markers and drawn all the proper cuts (with notes) on her ankle.
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magician
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Re: Knee replacement surgery

Post by magician »

When I had my first ACL replaced, two days before the surgery I went to the hospital for some tests (e.g., a blood-clotting test) and x-rays. After the chest x-ray I mentioned to the radiologist that I was having knee surgery and got a chest x-ray, and asked whether if I were getting heart or lung surgery they would x-ray my knee.

He didn't answer.
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statsguy
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Re: Knee replacement surgery

Post by statsguy »

greenspam wrote:a few more things....

1) the DECISION is more important than the INCISION. are you absolutely sure you need surgery ??? have you gotten a second opinion, and exhausted non-operative options such as painkillers or HA injections etc...

2) would recommend an academic medical center, aka a teaching hospital, as opposed to a community hospital. in addition to performing a large volume of cases, most academicians publish papers and train residents, so they are up to date with the latest research and clinical trials etc...

3) reiterating, as others pointed out, that the choice of implant type/manufacturer, and sticking to the rehab protocol, are equally critical as the choice of surgeon

4) remember to take a 'sharpie' marker and write "NO" on the non-operative limb, and "YES" on the limb which requires surgery.

good luck
:peace

(1) sadly yes... For the last five years the inside of my knee has been bone on bone. While the pain is manageable, I now am having problems with stairs, street curbs, and ramps. My knee is always swollen, been at least two years since the swelling went down. The pain is probably controlled by my meds - 3 800 mg ibuprofen every day. My current orthopedic has changed his mind from waiting to doing the surgery. He is mainly a shoulder surgeon and I want a more experienced surgeon.

(2) after some research have ended up choosing an academic surgeon who does his knee replacements at Cedar Sinai. Blue Cross Blue Shield rates Cedar Sinai as tops in our area for knee replacement, with UCLA a close second. I selected some surgeons at both medical centers as potential choices based on the information I could find. By the way, How can I find the number of surgeries performed?. I figured I would just add it to my list of questions when I visit the surgeon.

(3) will do. I am usually good about physical therapy.

(4) sharpie. Check. Seems unneeded but will do it. My shoulder surgeon, second and third surgeries, did it in preop.

Thanks for the great advice
Stats
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mapleosb
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Re: Knee replacement surgery

Post by mapleosb »

statsguy wrote:As everyone says doing physical therapy honestly is key. I have already had three surgeries to repair my shoulders and two on my knees. This will be my first joint replacement. My doctor is concerned that at 57 I will wear the joint out and have to repeat the process... so he has encouraged me to wait as long as possible. I have waited five years and while the pain is not great the knee is no longer stable. I am concerned I am creating other problems by waiting. Because of my arthritic condition I am at risk of needing my hips replaced too.

... My plan is to make an appointment and see if I am comfortable with him. Will also interview some of his previous patients (if possible) and talk to the caregivers where he has patients do physical therapy.

Thanks again to everyone who replied. I would welcome more information.
Stats,

I had both knees done one year apart. I spent a good deal of time looking for the right surgeon. I also spent a good deal of time interviewing and rejecting others. I was 60 when I had my left knee done. I went in for surgery on a Monday and on Thursday, I was able to walk out with a cane. I didn't spend anytime at a rehab facility, but started PT immediately at home for two weeks and then at the clinic for two weeks. The harder you work, the better will be the result. I was able to finally get to 0-129 degrees range of motion very quickly. The following year, I had the right knee done using a newer style "30" year implant and had very similar results with rehab.

Like you mentioned for yourself, I also was "bone on bone" prior to surgery and suffered many years for it. Now, everyday I take a walk it is like a new found freedom all over again. I think of the good doctor who made it possible and say a prayer for him each day. Everyone is different as are the results, but, if you decide to do it, I hope you have an excellent outcome too.

PS Take the pain meds and don't be a hero!! :lol:
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NateH
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Re: Knee replacement surgery

Post by NateH »

Larry Johnson wrote:Something missed by all of you is pivotal concerning knee and hip replacements. There are two types: PMA and 510k. 510k devices are experimental, and it is a felony for a manufacturer to represent they are safe. PMA ( pre-marked approved) costs hundreds of thousands of dollars to get on the market. 510k devices only require a showing the new device is substantially similar to a PMA device......
As someone who works in the medical device industry, i can say difinitively that larry johnson is wrong. :roll:
510k devices are approved by the same FDA for human use as safe and effective. If anything, PMA devices are more 'experimental' because they are a first-of-a-kind --- but they are still reviewed and their data are scrutinized by FDA before one is ever implanted in a human.

If you don't know the difference between PMA and 510(k), I assume you lost your pioneering lawsuit.
OP: Mr Johnson's bias is clear, but BEWARE of collecting medical advice on the internet, even from me. :beer
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Dan Moroboshi
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Re: Knee replacement surgery

Post by Dan Moroboshi »

You may not be able to get an accurate answer on how many procedures a surgeon has done. Most surgeons don't keep a running total of how many cases they've done over their careers.

I am a hand surgeon. I do a lot of carpal tunnel releases, trigger digit releases, and thumb basilar joint replacements.

I do not honestly know how many of those I've done over the years. But here's how I'd guesstimate:

I figure there are about 50 working weeks a year for me. I do on average about 4-5 carpal tunnel releases a week. That's 200-250 a year.

I've been in practice about 14 years, but I'm a lot busier now than I was when I started. So I guesstimate I've done about 2000-2500.

You might get a better idea of the surgeon's experience by asking how many knee replacements he does a week.

You can usually figure out how long he's been in practice by looking at his CV - don't count the fellowship year as a year in practice (it's an additional year of training on top of residency).

Multiply weekly # of TKAs x years of practice x 50, and you'll have a rough estimate. For an academic guy, the weeks/year factor might be 48 or 46, because they may have to attend conferences, serve as faculty at training seminars, and so forth.

I personally would avoid anyone who's been in practice less than five years, but that's just me. I know that's unfair to the new guys, but I'll bet most of you old timers out there will acknowledge that you were a much better surgeon at five years out than you were when you just started. (The difference between five and ten years is not as much.) That has been my experience, as well as most of my colleagues. (Some will never acknowledge that they've ever needed improvement.)

And don't forget as the patient you have some responsibility for your outcome. If you smoke, STOP. If your diabetes or hypertension is poorly controlled, get it under control well BEFORE surgery. If you are morbidly obese, make every effort to get your weight down. Tuning yourself up before surgery will give you the best chance to avoid complications and to achieve a good outcome.

And as others have said before, listen to the surgeon and the therapist, and do what they tell you. I've never understood patients who have the attitude "hmph, you can't tell ME what to do!". Hey, I'm not telling you just to be bossy - I want you to have a good result too. And if you don't listen, well you sure showed me... but I don't have to live with your stiff, weak, unusable hand because you didn't think you needed to do any therapy after I spent hours reconstructing your damn fingers after YOU nearly chopped 'em off. Yep, you sure showed me... (sorry about the venting, I actually saw this person in the office this morning.)
Last edited by Dan Moroboshi on Tue Dec 20, 2011 10:25 am, edited 1 time in total.
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Re: Knee replacement surgery

Post by VictoriaF »

Dan Moroboshi wrote:I am a hand surgeon. I do a lot of carpal tunnel releases, trigger digit releases, and thumb basilar joint replacements.
Do you joke with your patients? I would give my right hand for the benefit of your humor. :lol

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Dan Moroboshi
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Re: Knee replacement surgery

Post by Dan Moroboshi »

VictoriaF wrote:
Dan Moroboshi wrote:Do you joke with your patients? I would give my right hand for the benefit of your humor. :lol

Victoria
Well, usually not at first. I have to get a feel for people before I drop the default straight-arrow professional facade. But yeah, humor is beneficial for the doctor-patient relationship.

Nobody likes going to the doctor. Trying to lighten things up helps people feel at ease. And people like thinking their doctor is a real, live human being, you know?

But some people prefer the stodgy professorial type.
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statsguy
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Re: Knee replacement surgery

Post by statsguy »

FWIW two of my criteria have been number of years doing surgery and age.

For example, there were three surgeons with "good" bios. One had 8 years of experience (forgot his age), another has 14 years experience and is 45, and a third has 41 years service and is 66. So I did a little age discrimination... despite the fact that all three looked very healthy in their online pictures (who knows how recent the pics are) I decided my first choice would be the 14 years experience guy. I almost picked the one with 8 years experience figuring he probably was the most up-to-date, but in his bio his number 1 interest was no knee replacement but pediatric cancer surgery (a notable choice but not what I am looking for).

My plan is to go to the appointment and see what he has to say about my knee. I am interested in his take on my problems as a surgeon but will also be using the appointment as an interview process to see if I am comfortable with him.

Thanks for all the replies.
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livesoft
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Re: Knee replacement surgery

Post by livesoft »

As a veteran of 5 orthopedic surgeries, I see there is lots of good advice in this thread. However, it sure is hard to research a surgeon.

One can ask how many surgeries they have done, but the answer is not always clear. One can ask specifically, "How many ACL reconstructions did you perform in the last month? Last 2 months?" to jog their memory. One can ask the physical therapists who is good, but the PT know their referrals depend on the surgeon, so they are not always forthcoming either. One can ask colleagues and friends who have had similar surgery, but what do they really know?

My best research has come from asking my siblings who are physicians to do the research for me and also to ask my internist as in: "Who would you have do this surgery for you? Why?"
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Re: Knee replacement surgery

Post by magician »

livesoft wrote:My best research has come from asking my siblings who are physicians to do the research for me and also to ask my internist as in: "Who would you have do this surgery for you? Why?"
I asked my GP who he would have replace his ACL; excellent advice.

(He had suggested a cadaver graft (allograft). Three days after I tore my first ACL I moved from Southern California to New Jersey, and spent 6 months trying to find a surgeon who would do an allograft; everyone wanted to do an autograft (using my own patellar tendon for the graft). I asked my GP what he thought of an autograft, and he said that if it were his knee he'd never have an autograft.)

So, ask your GP who he'd use for his own knee, and what procedure / device / whatever he'd use for his own knee. Docs know.
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Re: Knee replacement surgery

Post by VictoriaF »

magician wrote:I asked my GP who he would have replace his ACL; excellent advice.

(He had suggested a cadaver graft (allograft). Three days after I tore my first ACL I moved from Southern California to New Jersey, and spent 6 months trying to find a surgeon who would do an allograft; everyone wanted to do an autograft (using my own patellar tendon for the graft). I asked my GP what he thought of an autograft, and he said that if it were his knee he'd never have an autograft.)

So, ask your GP who he'd use for his own knee, and what procedure / device / whatever he'd use for his own knee. Docs know.
If allograft is superior to autograft, why did New Jersey surgeons insist on doing autograft? Is it cheaper, easier, less risky?

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livesoft
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Re: Knee replacement surgery

Post by livesoft »

Even with all the research, one could still have poor results.

Quite a while after I had my ACL reconstructed, a cardiologist friend of mine told me about about his kid's upcoming surgery: "We picked the guy who does all the ACL surgeries for Manchester United. He's very good and highly recommended. He takes a bit of patellar tendon from the opposite knee and uses that. Blah, blah, blah, ...." A couple years after the surgery, the outcome is less than stellar.

PS: I am not so sure an allograft is superior. :) Docs are human and make lots of mistakes ... all the time.
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DSInvestor
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Re: Knee replacement surgery

Post by DSInvestor »

VictoriaF wrote:If allograft is superior to autograft, why did New Jersey surgeons insist on doing autograft? Is it cheaper, easier, less risky?
Here's a link to a paper called "Advantages and Disadvantages between Allograft versus Autograft in Anterior Cruciate Ligament Replacement"
http://soar.wichita.edu/dspace/bitstrea ... sequence=1
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Re: Knee replacement surgery

Post by magician »

VictoriaF wrote:
magician wrote:I asked my GP who he would have replace his ACL; excellent advice.

(He had suggested a cadaver graft (allograft). Three days after I tore my first ACL I moved from Southern California to New Jersey, and spent 6 months trying to find a surgeon who would do an allograft; everyone wanted to do an autograft (using my own patellar tendon for the graft). I asked my GP what he thought of an autograft, and he said that if it were his knee he'd never have an autograft.)

So, ask your GP who he'd use for his own knee, and what procedure / device / whatever he'd use for his own knee. Docs know.
If allograft is superior to autograft, why did New Jersey surgeons insist on doing autograft? Is it cheaper, easier, less risky?
I don't know. (This was 18 years ago, so my memory's a jot foggy.) Perhaps the patients preferred autografts (e.g., less risk of infection (say, from AIDS)). I will say that the route to finding a surgeon in New Jersey who would do an allograft (it took us through Brea, CA and Idaho!) was, to say the least, interesting.

My GP argued that with the autograft you have two surgical sites that have to heal, the patellar tendon is weakened (because 1/3 of it has been removed), and, apparently, there is a substantially increased tendency to develop tendonitis in the patellar tendon. The arguments seemed sound to me.
DSInvestor wrote:Here's a link to a paper called "Advantages and Disadvantages between Allograft versus Autograft in Anterior Cruciate Ligament Replacement"
http://soar.wichita.edu/dspace/bitstrea ... sequence=1
Succinct and to the point. Thanks for the link.
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livesoft
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Re: Knee replacement surgery

Post by livesoft »

I read the linked allograft/autograft paper. There is no date on the paper. It also does not mention that one can get a tendon from hamstring rather than patellar tendon. One can also use polylactide screws for the plugs.

My experience is that the surgeon will prefer hamstring or patellar tendon, so one can pick a surgeon that gets the tendon from where you want it. UYou can go to a surgeon that prefers patellar tendon and she will have all kinds of reasons why patellar is best. Or you can go to a surgeon that only does hamstring tendon and he will convince you that hamstring is the way to go. Unfortunately, that sort of leaves you up to deciding for yourself because you will pick a doctor. http://www.aclsurgery.us/patellar-vs-hamstring/
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