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

[Tfastle]

(I posted this about an hour ago and it's not showing up, sorry if it ends up being there twice)

Well I just returned from meeting with an OS. He didn't instill me with hope. My knee is pretty ugly and he pointed that out but he also said not to get my hopes too high that knee replacements aren't about getting back to the activities we did in our 20s and 30s but more about relieving pain and allowing for normal daily activity. He comes highly recommended locally and I am sure is good but I had hoped for a little more optimism.

I did ask if he cut any muscle and/or tendon and he said "yes", that they do "split" the patella tendon and it's the normal or most common way to do the surgery these days. Does "splitting" the patella tendon constitute "snipping" and is that indeed common practice outside of our community?

You do have a point Roy on finding the best surgeon and trusting his judgment. There is a surgeon a friend of mine is seeing in Phoenix that is highly regarded, specializes in knee replacements and uses the Journey II knee because, in his opinion, it offers a more normal movement than other devices. My wife (also a physician) thinks I should fly out and do a consultation with him which I may very well do.

The surgeon I saw today also said that most people do indeed find that the new knee feels different than their real knee and also bends differently and also that most hear some noise from them and have some clicking. Is that what all of you have experienced? Again, I know hips are less complicated and a different beast but with my hip, after 6 months or so of pretty hard rehab, I have had no indication that it's different than what I had before.

 

[Celle]

Your other post showed up, so I've deleted it.

Well I just returned from meeting with an OS. He didn't instill me with hope. My knee is pretty ugly and he pointed that out but he also said not to get my hopes too high that knee replacements aren't about getting back to the activities we did in our 20s and 30s but more about relieving pain and allowing for normal daily activity. He comes highly recommended locally and I am sure is good but I had hoped for a little more optimism.

I agree. This surgeon doesn't sound like the right one for you.
Coming highly recommended locally isn't always what it's about. You need someone who is more positive about the results of TKR and what he/she can do for you.

I did ask if he cut any muscle and/or tendon and he said "yes", that they do "split" the patella tendon and it's the normal or most common way to do the surgery these days. Does "splitting" the patella tendon constitute "snipping" and is that indeed common practice outside of our community?

I don't think that's common practice, but I will ask @Josephine to comment on your surgeon's comment.

 

[Josephine]

I don't think that's common practice, but I will ask Josephine to comment on your surgeon's comment.

I've already responded - see post #17

 

[Celle]

So, it looks as if this one is not the right surgeon for you, @Tfastle !
He sounds comfortable in his practice, but rather old-fashioned and set in his ways.

 

[PolarBear60]

The surgeon I saw today also said that most people do indeed find that the new knee feels different than their real knee and also bends differently and also that most hear some noise from them and have some clicking. Is that what all of you have experienced?

My new knee does feel different from my "real" knee. It doesn't hurt all the time. And, yes, it actually bends, which my "real" knee wasn't doing very well anymore. It felt better from the moment I stood up on it a couple hours after surgery. Yes, the leg was bruised and swollen and pretty sore, but that bone on bone excruciating knee pain was gone.

My left knee "clunked" at first. I'm sure nobody else could hear it -- I felt the sound transferring up inside my body and heard it in my head. Quite strange. After a few days, what I figured out was if I picked my foot up more deliberately as I walked, it didn't clunk anymore, so I checked with my PT about whether I might need some gait work, and we did a few exercises designed to work on that. Three years later I sometimes notice the left knee clunking, and when it does that, I realize it's because I'm tired and am not walking correctly. (I surmised nearly 10 years of walking like Frankenstein from being in pain resulted in some gait issues that PT and personal attention helped resolve.)

Perhaps oddly, my right knee (same brand and same surgeon done one year later) has never made any noise (but my patella made an extremely loud noise when it cracked six months later -- that put me in an immobilizer brace for a couple months while that crack healed -- better than new now).

The only part that feels different is when I try to kneel. That is a definitely uncomfortable feeling. I'm still trying to build up some front knee "toughness" to be able to handle kneeling. In my yoga class, on two stacked blankets, I've been able to kneel for maybe 20-30 seconds. Just today I tested my knees on a bare yoga mat, and I could kneel for a second or two. I have a ways to go before that gets comfortable.

My knees are three and two years old, and they are still improving. I'm able to do lunges and squats, but like SusieShoes, I can't sit on my heels. I never really could, so I'm not worried about that. Squatting is something I was prohibited from doing for about three months after my patella healed, so I just started practicing it in January of this year. I'm pretty pleased with how well it's coming along.

I don't run anymore, but last November, I did do a short trot with no troubles (just curious how it would go). I'm not sure what level of basketball you'd want to play, but if it was a laid back game you might be okay -- go easy at first and be careful about rapid direction changes and cuts. I'd be a little leery about that. Kicking a soccer ball with the kids shouldn't be a big deal after 6-12 months. Play that by ear. My surgeon cleared me to ride my motorcycle after three months, and one of the things I wanted to be able to do again, climb scaffolding, is something I'm thinking about doing soon.

 

[Doula1st]

I know every person and every knee is different. I can tell you that I researched very thoroughly who my surgeon would be (low infection rates, positive outcomes, and highly recommended in my area), HOWEVER....he chose a Smith and Nephew Journey cruciate retaining system for active knees and was terrible for me. The surgeon that did my revision 8 months later said he does not feel the Cruciate Retaining system allows enough room for good motion and has revised many of them. If I had it to do over, I would not have gone that route.

Best of luck to you!

 

[Jajakio]

I had TKR surgery almost a year ago. I'm nearly the same age as you and i was equally concerned about the right surgeon and the right hardware. One thing I found useful was the number of surgeons posing youtube videos where they describe their approaches to surgery and some discuss the hardware they use. If you google the name of the surgeon you are considering plus "youtube" you will be suprised at the number of surgeons with a short video where they describe their approach in detail. I'm near Nashville, so obviously a different set of surgeons, but I was initially interested in a quad sparing side incision with a sports knee and the 3d printed custom knee I ultimately chose. I watched specific surgeon's videos on both knees in the process of deciding who I was going to make an appointment with and interview. I think you will find most surgeons have a brand or at most a few options they like and are experienced with and you will likely be getting a package deal of surgeon plus a specific implant. In a way that's good as you want someone with lots of experience with the implant he is using. Maybe I'm a cynic but I don't think most surgeons choose the knee that is best for you of all possible choices, they choose the knee they like best and use it on most patients. Fine, but that means you need to look at multiple surgeons to find the right combination of experience and hardware. I also found a surgeon database that compared revision rates but I think that might have been Tennessee specific and I can't seem to find it right now.

I'm very pleased with my conformis knee. It starts with a CAT scan and then a custom knee is 3d printed which is supposed to be an exact duplicate of your original knee. After interviewing 3 different surgeons, this was my ultimate choice although the sports knee came close. I know many will say it doesnt matter which brand and honestly I never found a good study to point toward any one brand. I think successful surgery may be a combination of how bad your knee and general heath are, plus surgeons skill, plus a well fitting new knee. And maybe a good dose of luck.

I only know the minute I stood up after surgery it felt like my knee (my knee with a bad sprain, but my knee). It has never clicked or clunked. It took several months to get back to full activity but I did. I'm not a runner and never have been but I can bike and hike. Surgery will not take you back to where you were at 28 years old, but for me I certainly got most of my life back. Good luck.

 

[kneeper]

My OS said the best predictor of post op bend is pre-op bend. I think he didn't want me to be too in the clouds.
But I did get more bend than I started with. I'd say have a cautiously optimistic attitude and be aware that it will take time.

 

[Tfastle]

I am sorry for the slow response, have been a tad busy the last couple of days.

For those that described their personal experiences I do appreciate the detailed description, it is indeed very helpful. It does give some perspective and insight. It is amazing how different everyone's experience seems to be. I may be setting my sights too high but, better too high than too low I suppose. I have 5 screws in my knee and kneeling is a tad uncomfortable but no too bad. I can't imagine not being able to kneel for more than a few seconds. I certainly hope that gets better for you Polarbear.

I had no idea that range of motion would be impacted by what you had just before the surgery. I thought, with a complete knee replacement, range of motion would only be limited by how hard you were willing to work at it. I am curious if there are any others that might see this that had limited range pre-op and with hard work was able to get much more after?

Doula1st, that is interesting what you said about about the cruciate sparing knee not having enough room. I had read that, for people that want to be very active, that is good way to go. As a number of people here have said a number of times, it a combination of many factors for a good outcome and most importantly, a very good surgeon.

Jajkio, I did look for any video posted by the surgeon I went to but there was none. That is how I started to get an interest in the Journey II knee, by watching videos of various surgeons using it and describing how it's motion is different than other knees and it's design is for patients that want to continue a very active lifestyle. Most of the people I have talked to or even read about or chatted with online don't even know what kind of knee they have nor were they particularly interested in it. It seems to me that, like everything mechanical, designs and approaches get better and I would like to go with something that is better rather than something that is just okay (I will readily admit, many here who know much more than I about this believe they are all very similar and they are probably correct). How did you happen to have the Conformis knee as an option? Did you just happen to have a surgeon that used it and recommended it or did you want that knee and find a surgeon that used it? I am guessing a surgeon you saw recommended it because the other way, finding a surgeon that uses a particular knee (which is what I started out trying to do), is almost impossible.

Josephine, I did see your reply discussing the "quad snip" but from it, it's not clear to me if that is a completely different thing than "splitting" the patella tendon? When I asked if he cut any muscle and tendon he said that they split the patella tendon and that is the current most common practice. He did not mention anything about the quad or quad tendons. By "most common" practice I suspect he means locally or in this area but I am not sure. Do you know if splitting the patella tendon is common and not the same as a quad snip or are they both equally bad?

It really is surprising to me that there are not a couple (or a few) knee replacement surgery centers around the country where all they do is knee replacements and they are set up for people to be assessed via x-rays, MRIs, and phone interviews and they then travel to that site, have the surgery and travel home (that is how my hip was done). Or is there something like that out there?

Again, thanks very much for the comments and input! And good luck to all of you as well.

 

[Celle]

I had no idea that range of motion would be impacted by what you had just before the surgery. I thought, with a complete knee replacement, range of motion would only be limited by how hard you were willing to work at it. I am curious if there are any others that might see this that had limited range pre-op and with hard work was able to get much more after?

If you have a limited range of motion before surgery, it is probable that muscles and tendons will have shrunk. Although it is sometimes possible to stretch them again, you have to do that gently and slowly. You can't rush that because, if you do so, you risk tearing those soft tissues.

Working hard at it isn't the right approach, but working slowly and steadily can sometimes produce good results.

In fact, you don't need to work hard to rehab a knee anyway and working a newly-replaced knee too hard can have negative effects, keeping it inflamed, stiff and swollen.
It's not exercising that gets you your ROM (Range of Motion) - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

 

[Jajakio]

I guess it was a combination of the two approaches. I had an orthopedist I had been going to for years who specialized in knee surgery and I'd met a dozen or more people who had successful surgeries with him. Honestly , I did not even realize there was much difference between one technique or the other. He had explained a classic computer assisted surgery with, I think, a Striker knee and i was okay with that.

Then my insurance got switched and it was a huge mess and while my doctor was on my list, his hospital wasn't and i had to start looking for a surgeon all over again. That was probably the best thing that could have happened to me. It forced me to reevaluate. My old doctor said he could recommend someone else, but I also stared researching and found there was so much more out there than I had considered. I started reading up and watching videos of local surgeons and liked Dr Kutz and his video where he explained the conformis knee. I called my old surgeon and asked what he knew about him. He said he was excellent and he would refer me if I wanted to go. I visited 3 surgeons and considered other knees. I found a list of participating surgeons on the conformis website too. Does the knee you are considering have some kind of manufacturer website that might have a list of surgeons?

I did have my surgery at a dedicated orthopedic hospital. I think it's a pretty common thing in many places,. Most of what they do in that building are knees and hips. It was excellent. Nurses were with it, answered questions i hadnt even thought to ask yet. The middle of my hospital floor had kind of a physical therapy gym. They had told me to measure height of my bed and seat of the car before I came in and then they set the equiptment to those heights and had me practice getting in and out of car and bed and climbing stairs before i went home. I don't know if they are that good everywhere but I know two other people who were struggling with getting in and out of the car until I showed them what they had shown me in the hospital. I hope you are able to find the knee you want and an excellent surgeon too. Give a lot of thought to the surgeon too. The best knee in the hands of a mediocre surgeon may not be satisfactory. Be sure he is not only experienced, but experienced with this particular brand of knee. My surgeon told me he had done over 1500 conformis knees over the past few years.