Names of Surgeons, knee used (hardware) and why??

[Tfastle]

I am a 57 year old male and am seriously considering a knee replacement. When I was 28 I had a severe knee injury (tib-fib crushed, all four ligaments completely torn , meniscus shredded). After 5 surgeries and intense rehab my recovery was much better than anticipated and, with a lot of stretching and ice, for the next 29 years I managed to continue with a very active lifestyle (continue to play soccer, flag football, basketball, softball, mountain bike, ski, ice hockey, etc.). It always swelled up and I always iced and stretched it. For the last 15 years doctors have told me it's time but, to the extent I can take the pain, they said use it as long as I can. I think it may be time in that, even with management, the knee is starting to severely limit my activities and making sleep difficult at best.

If I do this I want to be confident that my choice in hardware and surgeon will give be the best opportunity at continuing to be very active. While I don't want to be a distance runner, I do want to be able to mountain bike, kick the the soccer ball with my kids, run short distances, play a reasonable game of basket ball, play ice hockey and so on.

The problem I am running into is, I can find little to no third party information on excellent surgeons who specialize in knee replacements for active people nor does anyone seem to really factor in "what particular" knee they get (which seems sort of crazy to me).

So, I have two general questions that I am sure could easily turn into lots of sub questions. One - for the people that did research, how did you pick your particular surgeon and why? (I would hope to find a surgeon that is an absolute expert at this and not a jack of all joint replacements.) Two - also for those that did research, what hardware did you go with and why? I have researched it a fair amount and, at the moment, would strongly lean toward the "Journey II" from Smith and Nephew. It's designed to move much more like a natural knee and is for active people (anyone familiar with it and your thoughts?).

Six years ago I had to have my left hip replaced (motocross injury when I was 24). I did very similar research and, as it turns out, was very lucky to find a website/forum that dealt with these questions in great deal. It covered the different kinds of hip replacement surgeries (THR and resurfacing), different surgical approaches, and the best doctors specializing in hip replacement surgery. Although I am in NM, ultimately I had mine done by a doctor in Seattle (Dr. Prichert) and chose hip resurfacing (after researching it I can't imagine why anyone would get a THR). My hip is as good as new and I have basically forgotten that I had it done. Of course I did intense rehab and still do my hip and stretching exercises but it really has been an amazing outcome that, had I not done the research I am sure I would not have had (I have two friends that about the same time went with a local doctor and had THR, both active and athletic, and both are very limited by their hips).

Knees are clearly more complicated joints than hips and I don't expect quite as good an outcome but, if I am going to do this, I want to make sure I've given myself the possible chance of achieving as close to it as possible.

So, if anyone has some input on their experience and why I would love to hear it. Also, if anyone knows of a source or forum on knee replacements like the one I found for hips please pass it along.

Sorry for how long and boring this is but maybe, for those interested in researching it, we can get a thread rolling that may get some helpful information out to those that want it (one of which is me )

If you made it this far, thanks for reading and good luck with your knee(s)!!!!!!

 

[Celle]

If I do this I want to be confident that my choice in hardware and surgeon will give be the best opportunity at continuing to be very active. While I don't want to be a distance runner, I do want to be able to mountain bike, kick the the soccer ball with my kids, run short distances, play a reasonable game of basket ball, play ice hockey and so on.

Your choice of surgeon is far more important than your choice of hardware. That's because, in spite of the advertising, there is really very little difference between the different types of hardware.
It's the skill of your surgeon that is the most important factor in having a successful knee replacement.

Once you find a surgeon you trust, tell him/her that you want to continue to pursue an active life and trust him/her to choose the appropriate hardware for you. That will be hardware with which he/she is familiar and has had previous successful results.

I would hope to find a surgeon that is an absolute expert at this and not a jack of all joint replacements.

You need to find a surgeon who does abut 150 knee replacements each year.
Start by using the "Find a Clinic" button at teh top of the page, make a short list, and then start phoning.
If you give her your post code, @Jamie may be able to recommend a surgeon.

what hardware did you go with and why? I have researched it a fair amount and, at the moment, would strongly lean toward the "Journey II" from Smith and Nephew. It's designed to move much more like a natural knee and is for active people

As I said, choose your surgeon, not your hardware. Choosing the right surgeon is the most important factor in a successful recovery.

(I have two friends that about the same time went with a local doctor and had THR, both active and athletic, and both are very limited by their hips).

That would be unusual. Hip replacement is a very successful operation.
Take a look at these and see what some people are able to do:
Stories of amazing hip recoveries
Dancing after THR: 4 months pics THR

By the way, BoneSmart also has an area that deals with hip replacements.

Knees are clearly more complicated joints than hips and I don't expect quite as good an outcome but, if I am going to do this, I want to make sure I've given myself the possible chance of achieving as close to it as possible.

Yes, a knee replacement is harder to recover from than a hip replacement, because the knee joint is more complex, but a good recovery is still possible. It does take time though, often as long as a full year, but the results can be excellent.

Look what some people can do after a TKR (Total Knee Replacement):
Stories of amazing knee recoveries

 

[Tfastle]

Thanks for the reply Celle. I had not seen the "Find a Clinic" button and will certainly explore that. I hope to find a surgeon that has done in the thousands which would correlate with 150/year.

I have done a lot of reading on the hardware and I am not convinced that that is not an important part of the decision although I do fully agree that most surgeons will use what they are used to using and have had success with. That can be good but can also lead to complacency. I hope to find a surgeon that is interested in the patient being very active again and addresses both the surgical approach he uses and the hardware he uses and why.

My only point with the THR vs resurfacing is that people should educate themselves and not just trust what their surgeon says. In my case, and I think most that are candidates, hip resurfacing is a much better option. But, if you don't know about it you are going to go with what your surgeon suggests. With hips, that generally going be THR because very few do resurfacing (a much more difficult surgery) and fewer yet are experts at it.

I'm all for getting the info out there!

I'll take a look at the clinic locator and post what I find out.

Again, thanks for the reply.

 

[Jamie]

I'm not sure where you're getting the information that hip resurfacing is something most people could have successfully, because that is not the case. It depends on each individual's situation and the condition of their hips. But, it can be effective for the right patient and I'm glad the procedure worked for you. If you'd like to provide me your zip code, I can help you search for a surgeon. I currently don't have any surgeons on my list in New Mexico. If you want the help and give me your zip code, be sure and tag me so I see your message quickly.

 

[Mutti3]

The brand of my prosthesis was not a concern. How many replacements my OS does a year and complications rate matters. My OS does knees and hips only, 400 hundred a year. My surgeon knews I enjoyed an active life style. Everyone is different, I didn’t do research beforehand. But he replaced my husband’s knees years ago, and had a very successful experience. I confidently choose the same OS. So far, I feel blessed with a great recovery. Strength, flexibility, balance and range of motion has all returned to a better state than before.

 

[kneeper]

I would explain your desire to do specific things when you meet with your prospective surgeon(s). He or she should be able to answer your questions about which implant etc.
My OS used different ones in each knee ( a couple of years apart.) I'm not sure if he switched brands in general or chose the one that he believed suited me best. Bottom line was I trusted him to choose. Which is not to say I didn't ask questions.

 

[yesyvonne]

My surgeon, who is a knee specialist -- similar to others mentioned above -- does hundreds every year, about ten a week, I was told. And has been in practice for many years, so his total number is probably in the thousands. I'm very happy with my outcome so far, three months out, and am entrusting him to do the other knee in August. I made sure he knew that I have been having local reactions to my earring posts and wires, and he said, okay, in that case, we'll be sure to use titanium. And so he did. I trusted him to decide specifically which one and get it in there correctly. Of course I'm not an uber-jock like it sounds like you are (that's admiring, not snarky, honestly), but I do want to be able to see the world on my own two legs pain free, and am aiming to do that by getting my knees done.

This is my surgeon: https://www.muirortho.com/doctors/ramiro-miranda/

May you end up with optimal outcome!

 

[SusieShoes]

As soon as I knew I wanted new knees I made a concerted search for the best surgeon in my area. I am fortunate to live in a region with excellent medical resources, so received many recommendations. I interviewed three surgeons I thought sounded right for me (they all did hundreds of TKRs a year, had low infection rates, and operated at hospitals with high ratings near to me) and scheduled with one of them.

The surgeon I went with was also the one who in person was most interested in what *I* wanted out of my surgery. I'm far from an athlete, but I did want to become much more active than I had been for years. Once upon a time I had been a very active person; arthritis and knee-pain had taken that from me. I wanted to get it back. I asked about the activities that were important to me: walking longer distances, kneeling, swimming (laps), and stairs. He said I'd be able to do it all.

I asked what prothesis he planned to use but didn't have a particular one in mind when interviewing. What was important to me was knowing this surgeon had superior results (according to nurses, other doctors, and PTs as well his patients I knew personally) using that prosthesis.

Whatever the reason, surgeon or prosthesis or the alignment of the stars, a year after having both knees replaced (bilateral), I'm doing it all. I may be the happiest camper on the planet.

Is the prosthesis used an important consideration? Of course. I read up on the ones mentioned to me. I knew of others from my research. But in the end I went with the one used by the surgeon I chose. I'm not enough of an bio-engineer to evaluate a device. Evaluating medical professionals, on the other hand, is something I KNOW how to do.

 

[Tfastle]

Wow, thank you all for the thoughtful comments. I will readily admit that I may be overthinking it but, as I mentioned, I want to give myself the best opportunity for an optimal outcome. Before I found out I needed a hip I knew next to nothing about them. I did a lot of research and ultimately knew a lot and was able to make what I think is the right choice (although I did have to travel to Seattle for it).

Jamie, my zip code is 87048 which is basically Albuquerque, NM. Thanks for checking for me. I probably phrased it poorly but what I meant to say was, for those that are a candidate for hip resurfacing I think it's the better option. I do understand that many people are not candidates.

It sounds like all of you were very thoughtful in your choices and I appreciate your input. With my hip I started with the "meet and interview" OSs approach but soon realized that was very inefficient since I had a good idea of what I wanted. After talking with 3 I came to the conclusion that finding OSs that fit what I wanted (resurfacing, posterior approach, minimally invasive, lots of them performed) was the smarter approach. On hips, it was not that difficult to find that info. I thought I would try the same approach with my knee but can find very little information on the specifics of particular OSs. Meaning what approach they use, computer assisted or not, hardware(s) they use (agreed, it may not be as important as I think), and most importantly, how many they have done. Not being able to find that information is what prompted me to post here. I even contacted Smith and Nephew and they steered me to a portion of their website that will tell you what OSs have used their hardware but it is very limited and does not say how many (the doctors themselves have to input that they use their hardware and most don't). The hip website I found had tons of information on the leading doctors across the country doing hip resurfacing including detailed information on their surgical approach, how many they have done and patients reviews and experiences with them. I am surprised there is nothing like that available on doctors doing knee replacements.

I will continue to look for the information online and will start calling some of the OSs I am considering to see if their office can give me the information but I suspect it won't be easy to get.

I am really glad you all had great outcomes and hope I will too. Yvonne, I enjoyed your uber-jock comment. :o) I wouldn't say I'm that but I do enjoy being active and really don't want to give it up.

Since I'm here, one other question for you all. One of the things I find myself fantasizing about is regaining range of motion. At the moment I max out at about 90 degrees, maybe a bit less. I envision getting back to normal with a new knee (135ish). Did you have limited range of motion pre-op and a great increase post-op? Ah ... the thought of being able to squat down and work on something rather than having to stick my right leg out is almost intoxicating! Thanks again. (uber-jock, that's funny!)

 

[SusieShoes]

I had limited ROM in both knees due to severe arthritis. About 85 in my left knee and 95 in my right. My left knee was definitely my worse one. I couldn’t squat at all, as you can imagine. Because of the pain, and the way my left knee would crunch on any bending, I didn’t bend to pick things up from the ground either. My left knee did not get to straight but was +9 degrees of extension and I limped all the time. My right knee could still get straight.

My knees today are 130/0 for my left knee and 135/-1 for my right knee. My surgeon measured them two weeks ago.

I can squat, kneel and get up again, lunge, reliably stand on one leg, and don’t limp. I had a very successful surgery. I cannot, however, sit on my feet... which is something my 84 year old mother with knee and hip replacements can do.

 

[Roy Gardiner]

One - for the people that did research, how did you pick your particular surgeon and why? (I would hope to find a surgeon that is an absolute expert at this and not a jack of all joint replacements.)

yup, a knee specialist is essential IMO. Maybe hips too, but the guy that did me is JUST knees. Hundreds a year is good.

I went to the hospital where he worked and wandered about looking dumb (just wandered about, really) and on 'Can I help you?' said 'Oh yes I'm coming here for knee surgery soon, wanted to look around. Dr Frankenstein is doing it, do you know him?' and off it went. The nurses know who's the best.

Two - also for those that did research, what hardware did you go with and why?

There's an old joke about having a dog and barking oneself. The surgeon decided.

Did you have limited range of motion pre-op and a great increase post-op?

You can get great ROM by doing stretching exercises. Every day. Bonus: no pain, pain is counterproductive.

 

[yesyvonne]

@Tfastle, you might check https://projects.propublica.org/surgeons/ ...although it looks like it hasn't been updated in a few years.

 

[Tfastle]

Thanks for the input Ray (what is your surgeons name?) and thanks for the Propublica website Yvonne. I poked around there quite a bit. I'm not sure how they gather their data but based on that, there are very very few OS that have done more than 400 knees and I searched a lot of hospitals including most in LA, Phoenix and Seattle. I suspect it's fairly accurate though. To do hundreds a year you would have to do pretty much one a day everyday. Yvonne what made you think it had not been updated in years? I did see that addresses hadn't been but didn't see anything suggesting how dated the data was. It would be interesting to hear back from people how many Probublica says their surgeon has done. It's very easy to check. ( https://projects.propublica.org/surgeons/ )
Roy, I hear you on going with the surgeon but technology changes and I would like to find someone that is on board with that.

One thing I did not discuss much above, how many of you had the minimally invasive/quadriceps sparing approach in your surgery?

Susie, that 135 must feel real good! Way to go!

 

[yesyvonne]

"Yvonne what made you think it had not been updated in years?"
@Tfastle, on the top of that linked page right under the headline it says updated July 15, 2015. I figure that means the data may be that old? And at the bottom of my surgeon's page is a footer that's probably common to the site, which says "About Our Data: Our analysis is based on billing data hospitals submitted to Medicare from 2009-2013."

In any case, looking up my surgeon, it says he's done the procedure 612 times. That may be only the portion of his cases that were Medicare-covered, since the data comes from Medicare submissions. And certainly he's done a lot more since 2013.

And his page says that his complication rate is said to be 1.8% "raw" and 2.2% "adjusted." But really, who knows what that means? My procedure had a bit of a complication in that I had very low blood pressure after the surgery so they wouldn't get me out of bed for the first 24 hrs. That's not the doc's fault; that was me.

In other words, I'm not exactly sure how to interpret the site. And I do know that I'm doing really well three months post-op, so I'm happy I chose the surgeon and hospital that I did.

 

[Celle]

When you read of minimally invasive knee replacements, don;t go thinking of keyhole surgery. The incisions still has to be large enough to allow complete access tote h knee joint and to insert the prosthesis. The scar will probably be about 4 inches long.

Although the proponents of "minimally invasive " knee replacements seem to make a big thing out of them being "quad-sparing" very few surgeons nowadays actually cut the quads anyway. They all use a technique that allows the quads to be pulled aside, instead of snipped. It's the slightly different angle of approach used by surgeons of the "minimally invasive" technique that allows slightly less handling of the quads. The more gentle a surgeon can be with your soft tissues, the less painful your recovery might be.

Have you seen this article?
Knee replacement surgery types and suggested videos

 

[yesyvonne]

@Tfastle, you asked, too, "how many of you had the minimally invasive/quadriceps sparing approach in your surgery?" Yes, I did. My entire incision is only about 5". Astonishing that he could get in there, dig the old knee out, and put the new knee in with such a short incision. It stops at the top of my knee so he didn't cut the muscle above the knee, it seems.

 

[Josephine]

I have done a lot of reading on the hardware and I am not convinced that that is not an important part of the decision.
One of the things I find myself fantasizing about is regaining range of motion

Let me tell you, I've been in this business of joint replacement for decades. I've watched it all 'grow up' from infancy and I know that one knee is pretty much the same as any other. I got that from the National Joint Registry (UK) 2017. That's their findings after years of collecting data on the subject. That basic design is proven, the rest is all just tweeks and of no importance whatsoever. They'll all give you pretty good outcomes (including ROM).

Did you have

I do recommend that you don't pay too much attention to what other's experiences were. All knees are different, all surgeries are different, all recoveries are different and all outcomes are different.

One thing I did not discuss much above, how many of you had the minimally invasive/quadriceps sparing approach in your surgery?

Quads snipping was done routinely back in the day but pretty soon, surgeons realised that it just interfered with the patient's recovery so they stopped doing it. That was back in the 1980s! So I suggest if you find a surgeon who still uses that outmoded procedure, you run, run, run out of his office immediately! The best surgeons don't use that technique any more!

 

[Tfastle]

Ah, I see it now. So this data is only on medicare patients and only covers the 5 years from 2009-2013 so one could assume the actual numbers are indeed larger, maybe 20% or so (very rough guess) and then divide by 5 to get an idea of what they are doing each year. I am seeing surgeon tomorrow and it says he has done 300 so I would guess he is doing about 70/year. For all of New Mexico he has the second largest number and, after looking at a lot of areas, a relatively high number which is good.

I wasn't thinking keyhole surgery or even small scar (don't really care about that) but do not want any muscle or tendons cut which, in my mind, was what I meant by minimally invasive. Thanks for the link to the surgery types and videos, makes it much clearer and was very helpful. I was not aware that the general standard now is to not cut muscle or tendon but sure think it's a good thing. And yes, it's absolutely amazing they can access the entire knee and do all of that work through such a small incision.

Again, I very much appreciate the input and information. I will pass along what I learn from my appointment and, no doubt, have more questions!

 

[Celle]

do not want any muscle or tendons cut which, in my mind, was what I meant by minimally invasive.

Surgeons who still do cutting of muscles and tendons are in a very small minority and should be avoided. Take on board what Josephine wrote, here:

Quads snipping was done routinely back in the day but pretty soon, surgeons realised that it just interfered with the patient's recovery so they stopped doing it. That was back in the 1980s! So I suggest if you find a surgeon who still uses that outmoded procedure, you run, run, run out of his office immediately! The best surgeons don't use that technique any more!

 

[Roy Gardiner]

Thanks for the input Ray (what is your surgeons name?)

Won't be much use to you I'm afraid unless you come to London; it's John Ireland, living in Woodford in Essex, England

Roy, I hear you on going with the surgeon but technology changes and I would like to find someone that is on board with that.

My view is that my job is to find the best surgeon possible and then accept that he knows more about his line of work than I do. I did indeed find someone who would do a customised knee, aided by computer; but it would've been his first attempt at new technology. I went with what John said, and it's been pretty good!

Having said that, you are IMO still right to do your homework; it gives you confidence, and enables you to ask questions to help select the correct surgeon - the most important decision in this whole process.