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Custom fit TKR

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elcammeno

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May 14, 2007
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I recently came across the internet about custom fit tkr. It is done in Houston, Tx by Dr. Larry L. Likover,M.D.,P.A. It is a computer designed custom fit tkr that restores your knee to the way it was before you got arthritis. The web site address is broken link removed: https://www.drlikover.com/knee_replacement.html. I an wondering if this is for real?? Has anyone else heard of thisor know anything about it?

Elcameno
 
I have an Otis knee, it is custom fit and I am getting my second one on 3/14. I had mri on my knee and then it was sent to CA to have the knee made. So far I am very happy with it. I don't recall, but someone else on this forum is getting an Otis knee as well.
My Dr. is Dr. Ronald Lippe of OIP in Harrisburg, PA. He has been using this knee since it was developed and has great success with it.
I really didn't research too much further on the knee after his explanation I felt comfortable compared to other knees I had read about and I trust him so that's what I went with. Sounds very similar to the one you are talking about.
 
I corrected your link, elcammeno, as it wasn't working.

The custom fit has been around a while. The theory of it is fine but is incredibly expensive and wouldn't actually seem to have possess long term benefits over and above any other prosthesis. From discussions amongst surgeons I was party to when it was first brought out, the overall benefits seem minimal, not justifying the additional cost.

So far as other prostheses are concerned, they have quite a range of sizes fo both component with only millimetres of difference between the sizes. For instance, there are ExEx large, EX large, large, medium, small, ex small and exx small in most makes, with tibial inserts from 5 to 15 milimetres in thickness in 1 mm steps to make up for bone loss which almost always occurs in the tibia. The general view is that this makes an assembly that is pretty much "custom fit" anyway.

However, you pays your money and you makes your choice. If you like the idea, then by all means go for it.
 
Thank you for your reply, Josephine. I feel better now going into my surgery March 5th. There is one thing that I'm still concerned about though. Both my knees need TKR. Right now I have plans to do them 5 days apart. I have heard others say that having had this operation, that they were so glad they waited to do the 2nd knee later, like months.That way they had at least one knee they could use for balance after having the surgery. So I am debating what to do about that. Also, I would think I would be weak going into another surgery 5 days later. I would prefer going into another operation so soon to be strong. I would appreciate hearing from you on this. Thanks.
Elcammeno
 
5 days later? Hmmm - that is curious - never heard of that being done before. What country are you in? Has the surgeon suggested or agreed to doing this? If the knees are going to be done that close together then I can't see why they wouldn't be done simultaneously.

It's also a problem concerning the rehab - the first couple of months is crucial for good rehab and I would have thought that having a set back like that could be counterproductive - but that's just my opinion.

There is also a 'window' in surgery of 1-6 weeks where embolism is more of a risk and therefore another surgery and/or anaesthetic is unwise.

Otherwise, I am puzzled.
 
Back to the original post on custom fit...just a thought

It is fine to explore current technology options but in the end it comes down to what your insurance will authorize and cover in the US.

My current billed charges (not the discounted insurance rate) for a DePuy rotating plateform knee that was covered by my insurance is $45,000+ US including PT.

You will be limited to in-network services with your insurance coverage unless you want to pay out of network services fees.

It comes down to your insurance restricts you to in-network OS's and the OS has a preference regarding what TKR appliance they will use. You will have to do research on what in-network OS's use which suppliers components and what the benefits of one over the other for your case will be.

Gotta love the Medical Insurance industry in the USA...

On edit... I forgot to mention that the insurance negotiated in-network cost was $22,000. All the players involved in the surgery write the difference off their taxes as a loss (the games we play in the USA). I would assume since there are no negotiated procedure costs for out of network providers that you would be looking at paying the difference in the in-network price and your out of network costs depending on how your insurance policy is written.
 
Again thank you for reply & concern. To answer you as to where I am from, I am from the U S. The surgeon suggested that I do my knees 5 days apart, it wasn't my idea. He has told me that doing them simultaneously is hard on the system ( cardo system & lungs). I am 68 yrs. I just feel now that it may be safer to do the 2nd knee some months later after I am done with rehab for the first knee. I know of one person that came out fine doing one knee & then the other knee 5 days later by this doctor, having done it this past fall. Sure would like to know if other doctors do this.

Elcammeno
 
Josephine- I forgot to mention that after my first TKR I will be having an injectable medication of either Lovenox(enoxaparin) or Fragmin.(dalteparin) Also will have been through some of my rehab. Am thinking that would protect me from the embolism???
Elcammeno
 
Oh yes - that is standard practice now but the key word is protect. It's still a risk.
 
Just a thought,but I would think that any anticoagulant or antiplatlet medication would have to be discontinued prior to another surgery to decrease bleeding risks, unless heparin would be used. Heparin can be stopped just hours prior to surgery with blood coagulation returning to normal. Then again, I would tend to think that stoping the medication would put you at risk for increased chance of clotting. Sounds like a catch 22 to me.
 
The anticoagulant therapy is commenced with the anaesthetic.

.
 
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