TKR Brownie's Good, Bad, & Uglies

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I agree with Margaret that probably MIS is less important than your other criteria. Although, if I recall, your first doc actually cut your quads which is really unbelievable. I would not allow that---my quads are too important to me and I don't want scar tissue there since it is unecesary to cut them in this surgery. I think that the whole MIS thing grew out of those docs who did not want to cut the quad muscles----perhaps you might ask who does "quad sparring" surgery which, in my opinion, is very important.

I don't think you are wrong to pursue this---it is important to you and I agree that you are the consumer and have the right to find the kind of doc you want. There is a doc in Kalispell that you would love---he is kind, considerate and a great surgeon. I am sorry that i did not find him myself. I am confidant that there is a doc like that in LA and why not find him? I would not have this surgery with someone I did not like and with someone who did the quad cutting surgery.

I don't blame you for looking around---I am equally demanding about my docs and like you, I have a great lineup behind me and I am glad that I looked around.
 
Hi Brownie, i have neen reading your thread with interest and I must ágree with Kelly where she says that you shlould be looking for quad-sparing surgeons, not just MIS. The important thing is to not get your quads cut! The surgeons that do QUAD-SPARING do not use a tiny incision but much smaller than the ones that use the old way of cutting but they can still do good alignment.
Good luck in find the best surgeon.
 
OK, last thought from me: What's going to matter to you more in 5 years -- the length of the scar or the function of your new knee?
 
The quad sparing thread discussion occurred Here Orthodoc explained the term and MIS in detail for us. :thumb: It should also be in the BoneSmart library.
 
I tried to find out about hospital infection rates but I didn't get anywhere.

Does this help?
broken link removed: https://cdph.ca.gov/programs/hai/Pages/MyHospital-HAI.aspx#/@6/33.659/-117.772?tab=COLO
 
Thanks Elisea! 2 of my hospitals are "the same" as other hospitals in the knee department and UCIrvine does not have any information. I appreciate the info! Now I wonder if it's out there for the doctors!
 
Thanks Oldie I agree. I do ask about quad sparing not MIS but it is often used interchangeably as we have seen on Bonesmart. I understand that the incision is more like 6 or 7 which is much shorter than mine. Pdx I have anever had a concern about the length of the incision. I have discomfort still where my quads were cut, it is tender across there and I can still feel it. I guess it worries me about the future that I might have excess scar tissue so if I can avoid that extra incision I will. When I bend my knee it feels like there are cords in there pulling and "flicking".Maybe at 6 months that's normal. But I hear so much good stuff about NOT cutting the quads so if it is possible for me to find a doctor that I can trust to do proper alignment as well, then I will switch doctors. Otherwise I will stick with Dr. Spitzer.
I am now checking out Ran Schwarzkopf at UC Irvine and Jason Snibbe at Cedar Sinai. Seems like they both have great credentials. Dr Schwarzkopf even answered my email where I asked about his procedure. Dr. Snibbe even teaches the minimal approach to other doctors in other countries.
Kelly I agree! I actually considered going up to U of Washington where Randy's guy is. I had watched his videos before my first surgery. But I think he would be out of network plus it's so inconvenient although I could be following by my Kerlan Jobe guy down here post op. I think out of network could get out of control!
So this week I will let you all off the hook with this and have a decision I hope! I am sick of hearing myself talk about it and I can only imagine how you guys feel!
Thank you all!
I will do the reading you recommended!
 
Margaret-Yes computer navigated uses computer right at the operating table! I haven't run into anyone who is doing that. But Dr. Spitzer does use the computer to figure out alignment, using some kind of program, with the patients xrays on it. Where as Dr. Klapper uses the old fashioned film xrays that you put up on the light box and that have to be copied rather than put on a CD. I have not run into anyone that still uses the old film X-rays except Dr. Klapper. So many things that you have to ask about. Not that you would change your mind about a doctor based on one thing, but after I got on Bonesmart I gained some education about this. Then once I'd had my surgery I gained even more. If only I had found Bonesmart before my first surgery and done all this investigating before I made my decision. Thanks!
 
My surgeon does hundreds a year, teaches other surgeons, uses minimally invasive, CAD/CAM and is also a freak about preventing infections. He knew infection rates and could quote them at a moment's notice. I started to touch my incision after he unwrapped it the next morning and he stopped me in mid air with a "nooooooooooo" and then proceeded to quote infection statistics for the next several minutes. :heehee:

For the MIS, it had to do with the surgical approach more than a length of a scar. Using smaller tools, moving the knee around to get a surgical window, not flipping over the patella but instead moving it out of the way, etc.

I also had real time computer assisted CAD CAM software used in the operating room to align the knee. Perfect alignment is supposed to assist with keeping down the wear and tear on the knee. IT allows for a closer and more aligned knee than even the most experienced surgeon can accomplish. Mine is within 1 degree of perfect alignment, so as I tell people, I am within one degree of perfection.

It took me many many months and interviews to locate an OS that fit with me. All the best with your decision, Brownie! :)
 
Brownie, Elisea's doc is just like mine. He teaches MIS techniques to other docs, He uses the sub vastus approach, sparring my important quads, he does not flip the patella over, which decreases the trauma, he does 300 knees a year, he uses smaller tools designed by Stryker, just for him and he also uses CAD CAM software in the operating room. Plus, his infection rate is the lowest in the two hospitals in the area---he is unbelievably strict about infection--in fact none of the nurses could touch my bandages when I was in the hospital.

I think you should take the time to find that type of doc for your knee too.
 
Recently, Brownie and I have carried on a private, parallel conversation to this thread. I think she has done a good job in trying to find the right surgeon for her 2nd TKR.

One important thing that occurred was that one of the prospective surgeons Brownie sought out sent out some "red flags." It can be difficult to find the right surgeon, and in the end there is a leap of faith and trust. There are lots of good surgeons. and One thing most informed patients can do is to avoid the possible kooks (there are a few out there).
 
Brownie, I was wondering if you had made a decision yet about your surgery. Are you still interviewing docs?
 
Hey Kelly thank you so much for finding my thread for me!!!!!! I know you say it's easy but....
Yesterday I emailed Dr. Spitzer (right knee surgeon) and cancelled my surgery. Good old Wilbur, you've heard about him before!, has had over a week to fit me into the schedule to see Dr. S but has played his little games. The scheduler called me because after Wilbur never responded to my request for an appointment (he has to put in the squeeze in appt, front desk can't do it) I emailed Veronica the scheduler. She called me and I talked to both of them on the line. He was snotty but thats okay, VEronica said, Wilbur is standing next to me. I am going to transfer you to him so he can make your appt. He let it go to voicemail! So I left a message and then called back a half hour later. A male who sounded like Wilbur, quickly said, "Wilbur gets off at 430 and it's 431" End of conversation. So I waited and waited. As of Friday he still has not called me to set up the appointment. Clearly he is not going to do it. And also I feel it's clear he will do everything he can to postpone my care and this will result in my surgery also being post-oned. So I am done with them.
That was this past Monday that the call transfer happened. So I resorted to calling my ex husband who is a physician in Palos Verdes, next to Torrance. He gave me a couple names of good guys. So it turns out that there are lots of docs in Torrance who are doing the MIS/quad sparing. Using the mini tools that Zimmer (my knee) provides for them. I liked Dr. Albert Reff's website and office secretary. Office is in Redondo Beach, which just 20 miles from here and does not involve Los Angeles traffic. He has photos of the office and it looks normal, no old photos of movie stars in the exam rooms, ha. He is listed on the Zimmer website for all the procedures he does. Knees are his thing I have not met him. He will be back from a medical leave in 2 weeks but I get to meet his consultant who is covering for him on Tuesday. I know this is premature but it just feels right. The secretary even worked in my ex h's office in the past and we had a good laugh as my ex had tried to set her up with his younger brother. Another ortho Dr Todd Shrader was recommended. I called them too and the secretary was a real complain! And this is where my ex-h actually sends most his patients for follow up care. I knew the older Dr. Shrader when I was working in the hospital. He also is on the Zimmer website and does the less invasive procedures. I realize you should not chose your doctor based on their office staff but I thought that woman, PATTY, could be another Wilbur!
I did go see some other docs. Klapper and one at UCI. UCI guy told me that my arthritis is not bad enough to do a replacement. He lifted up my leg and bent it back and forth and there was no pain. Nope there never was in my other knee either! He said come back in 2 months and that wouldn't it be great if I didn't have the replacement for another 5 years when the arthritis is worse. How do I walk any distance in the meantime. Klapper took xrays on a machine from the 60s and showed me that my bones were touching in the medial spot. He gave me a surgery date and a girl had me come to a counter to tell me the things I needed to do before the surgery. I had to ask to go sit down in a private area! Otherwise she would have done the whole thing in front of the front office and while standing. Funny! Anyway he's not meticulous like the Dr. Spitzer and other doctors about infection prevention etc. he told me my bend in my TKR was only 90. I had just gotten off the freeway and was wearing stretch long jeans! I said, no it's not, it's 130! I'm wearing jeans. So he pushed my other knee in and said, that's 130. I said I'd like to have matching knees. He said he'd try but that I probably shouldn't have had my zimmer nexgen and the lack of flexion proves that. He said I will try but if I get in there and the ligaments aren't good enough I am going to put in a johnson and johnson. He talked quickly and it was hard to catch it all so I am doing my best to give a thorough report here.:) So then the UCI guy. Then the Wilbur... and I realized it was never going to happen. Even if I would email Dr. Spitzer and get the appt, Wilbur will find another way to screw it up. He did that pre op and also post op.
So hopefully this new surgeon is going to be the one for me. If you check his website you can even see that he has the Bonesmart philosophy. So once I saw all that and Wilbur still wasn't responding it seemed okay to cut my ties with Dr. Spitzer. He is doing a study with a colleague regarding the approach to use when the tkr patient has tumors. I had the chondroma (benign) right in the way of the cuts so he had a custom implant made that does not involve cutting into and dispersing those tumors. His belief is that it is possible that by doing so, the tumor cells are spread through the femur and could possibly mutate (not his word) and turn into cancer cells later on that would be difficult to treat once they'd been spread. Dr. Klapper poopood that whole thing. Personally I appreciated his being so meticulous.
So I feel bad that he won't be able to follow me but how the HECk would I get an appointment anyway? The front office said they couldn't give me an appt until June which is when my surgery was scheduled and so they told me it was Wilbur who had to put it into the schedule. Actually this also happened when I went for my 2 months visit. I was coming back in 2 weeks for Synvisc in my left knee. He came up to the check out desk upon request of the front office to make the 2 week appt. But he had to put it into the computer. he said he would, but he didn't. So when I went in, which I had started working and had to leave early and drive 35 miles they said it wasn't in the computer and wouldn't let me see the doctor. Low and behold the front office had given me a card and I pulled it out, so they called for Wilbur. He told me I can't see the doctor and I said, oh no I came all this way leaving work and I am going to see him and get my synvisc. So then he told me I have to have prior auth for the Synvisc from Blue Shield. I said NO the synvisc comes from my medication plan, a separate company. It's just an injection as far as Blue Shield is concerned. I also said I discussed all this 2 weeks ago with Dr. Spitzer and told him about my medication plan. Dr. told me "dont worry about it, we'll take care of it". Wilbur laughed and said, he doesn't know anything about this, such as the insurance end of it. Wilbur also told me alot of factoids that are simply not true about my insurance, telling me blue shield has been refusing to pay on synvisc. Mind you all of this is with he and I standing in the middle a full waiting room! That's my wilbur! I have other stories but my fingers and your ears are both wearing out! MY point was that I feel bad about dropping out of this type of study. Dr. said you can follow the progress of a tumor when you leave it alone but not when it gets spread into tiny bits.
So I am really hoping that Dr. Reff is my guy. My ex will probably refer to him more if I'm happy. I was so excited when I read his experience with MIS type procedures.
Okay Kelly what do you think????? Weigh in please :friends:
 
Brownie, I just did a search with your name only. All of your posts came up and your own thread was on the second page!!! I think that I agree with you that I would not put up with Wilbur for one more minute. Dr. S hired him and continues to employ him, so he must like what he is doing---therefore, I commend you for canceling the surgery, smart!!

Dr. Reff sounds a lot like my guy---I like the website and I like the attitude. I also agree with you that I will not deal with a doc who has crabby office staff. My husband's internest has hired one dummy after another--he is constantly complaining since she even messed up a flu shot!! I do what you do---and calling your ex husband was a smart way to go. I also like that you don't have to drive through a lot of traffic to get there. I am so spoiled living in a small town---my doc is 8 miles and 15 min away, which I think is a big deal!! Brownie, I think you are on the right track and this knee will be easier than the last one. K
 
Marianne if there was a prize you would win hands down. Your poor little hands. I have read it tho and all very interesting and makes me happy we don't have to go thru insurance. My second TKR is getting to be a sure thing this year no matter how hard I try to ignore the signs. I don't know if to wait a while till op knee grows stronger ROM still very dismal or go ahead sooner and get it done while it is in better condition and maybe get a better recovery. Hard decision..
 
Thank you ladies! You are the only ones who made it through. The others have all fallen asleep or just said forget it! hehe
So Pat when do you think you might have surgery? How does the process for getting your surgery scheduled work?
Kelly after my last consult who thought I could go another 5 years, I decided I would push the walking. I got down to the end of my street and came back. Example...I can go INTO the grocery store walking great, maybe not even any pain but when I come out I have a limp and I'm hurting. So it seems like everything is fine at work but then if I had to walk to the stadium or something I'm in pain and the limp comes back. I bet this is pretty typical of us bonesmarties?
 
Hi Marianne. Our process is quite simple. When i went for my six week check with my OS he gave me an appointment for 12 months time BUT if i wanted the op before just ring and get an appt and he will arrange a date for me. He was quite willing to give me a date for last February as my knees were both in the same terrible condition but i honestly couldnt have contemplated a second op so soon after the first. My operated knee is very good at the moment but it still gets swollen and I ice and elevate as normal. My ROM is still only 90/95 so I have an appt on the 14th to see a physio to see if there are any problems. Id like to sort that out before I think of my next op.
 
Brownie, when you have a limp which leg/knee is the problem--the one with the tka or the other one?
 
Brownie, ...we should all send some good karma your way...really hope this doc turns out to be who you need.
 
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