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Questions about MAKO surgery

pdlinda

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I am scheduled for a MAKO RTKR on October 4th. I also have 25% valgus and my leg is very crooked.

I go to
my OS PT facility 2X/week pre op and the patients I see segueing from surgery to OP PT are all doing GREAT!!

I interview as many post op patients as I can and all give me a heads up.
 
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Poctdb

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@pdlinda
My OS said my knee looked like “a candy cane.”
The X-rays said 27% valgus, OS said Mako said only 20% using the CT.

Since I am a laboratorian who deals with precision day in and day out, I found that difference interesting.

In this case, the numbers did not matter. Mr. Knee (and the leg in which he resides) is now straight and normal.

MAKO as a capital purchase for a hospital is steep. The surgeons that use it in my 6 hospital system share one device in one hospital. According to my OS there is some significant surgeon training to use it.

These two items may limit the “everyone would be using it” logic for now. But as @Jamie says surgeon skill is the factor that is the most important. My OS said that the recovery time with MAKO is the same as without it.
 
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pdlinda

pdlinda

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Poctdb:

My OS is a sports Med guy who has an impeccable reputation and didn't even consider doing TKR surgeries until and unless he could use the MAKO.

I met him (referred by a friend)!in 2017 after another OS replaced my right hip. When the PT team came to my home immediately following the hip surgery and started me on PT exercises I experienced instant grinding and clicking of my KNEE!! I had arthroscopic surgery on that knee in 1996 and never thought a thing about it for all those years!

Because of the KNEE issues my recovery from the hip surgery was much longer and more difficult than the recovery I had after my LEFT HIP was replaced in 2008.

In 2017, because I was still experiencing knee difficulties I consulted with the doc I'm with now. He told me he was completing his training on the MAKO.

He has a thriving practice and has no partners. He just bought a new building because he's outgrown the space he's in now.

I've been going for PT at his facility since January 2019 in the hopes of saving the knee. However, after a trip to my children/grandchildren in March when I felt my knee was going to collapse I knew the time had come to bite the bullet and take the plunge with the MAKO.

I'm still going to PT and follow up with the OS every 2 months.

I look forward to having a straight leg and getting back to hiking and living the active life I enjoy.
 

Jockette

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My OS is a sports Med guy who has an impeccable reputation and didn't even consider doing TKR surgeries until and unless he could use the MAKO.
How long has your surgeon been doing MAKO knee replacements?
 
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pdlinda

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Jockeyed

He began using MAKO in 2017
 

kneeper

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Not quite the same thing, but interestingly my OS used a computer guidance system with my first knee but not with my second. IIRC he said he didn't find it got him better results. My 2nd knee is great, FWIW.
 

Celle

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How many knee replacements has your surgeon done, @pdlinda ?

It's not the type of knee replacement, but the experience and skill of the surgeon that is the most important factor in having a successful knee replacement.

We usually recommend that a surgeon does a large number of knee replacements each year.
 

Jamie

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It's all about the experience of your surgeon. We recommend a surgeon should be doing at least 150 knee replacements per year. Normally we advise BoneSmarties to be wary of Sports Medicine doctors doing knee replacements because they just don't have the opportunity to do enough of them. Sports Medicine docs usually do a wide range of procedures instead of specializing in joint replacement.

Knees are especially tricky because of the balancing that must be done with ligaments to make everything work properly. There is a bit of an art to this that has to be learned over time. In most cases you'll have a better chance for a successful surgery and recovery if you find a surgeon who specializes in knee and hip replacements. They will have the most experience under their belts and will know how to handle any issues that may arise during surgery.
 
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pdlinda

pdlinda

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Celle & Jamie:


Thanks to both of you for the info you are providing to me.

I will call the OS office tomorrow and get specifics regarding how many of these MAKO knees he's done.

I completely agree that this info is crucial in me making sure he's skilled and experienced enough to give me the best result.

I have been going to his PT facility 2x/week since January, 2019. In every instance there is always at least one post op TKR patient being rehabilitated.

I will post as soon as I have the info.

Again, many thanks!!!
 

Josephine

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1. In 2017 he told me he was completing his training on the MAKO
2. He has a thriving practice and has no partners.
I agree with previous posters. These two issues I've quoted at all BIG red flags to me. He might be nice but I wouldn't want him operating on me!
 
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pdlinda

pdlinda

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Celle, Jamie and Josephine:

I called OS office this morning and wasn't particularly pleased with the answer I got. Med Asst I spoke to seemed surprised by my question.

She said he schedules from 1-4 MAKO TKR's each Friday but wasn't sure about how many he's done in total.

If I were to explore finding another OS am not sure where I would start.

Am not sure if the MAKO would be important in the selection process.

My 2 hip OS's were excellent but both retired due to developing arthritis so I'd basically have to start from scratch finding the best doctor to replace my knee.

Any suggestions about where to start would be appreciated.
 

Jockette

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My 2 hip OS's were excellent but both retired due to developing arthritis so I'd basically have to start from scratch finding the best doctor to replace my knee.

Any suggestions about where to start would be appreciated.
I’ll tag @Jamie for you.
 

Poctdb

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@pdlinda
I have asked 3 different OS “How many TKR per year does it take for a surgeon to be “good” at TKR?”

All answered 200 or more per year. The number was irrelevant as far as MAKO/no MAKO as that was not included in the question.

The Medical Assistant that you spoke to would probably have no idea. If you do this by phone, ask for his Surgery Coordinator who is most likely an RN. She probably has access to the stats. If there is resistance to the question/finding the answer, for me that would be a flag. Ask specifically “How many TKR does he do per year?” How many of those are traditional TKR and how many does he use MAKO?

Is there the ability to send an email to the practice? Usually RN alone answer them. You can be very specific in an email. That would be how I would try the query first.

Phoenix is place with lots of hospitals, 4 major systems that I know of. There is one system I know of that is located in Scottsdale, but has hospitals in Phoenix.

If the answers you receive eventually are not satisfactory to you, start by pursuing research on all of those systems websites. Send them an email specially asking about Ortho/TKR through their site. You will have leads on surgeons quickly if you find the prolific Ortho system there. (Based on my familiarity with that area-an aunt lived/died there and had lots of visits to hospitals, I have inspected hospital system laboratories in the Phoenix area, my guess is one hospital system will stick out quickly in your research.)

A system that does lots of Ortho usually trumpets that on advertising due to the fact that Ortho makes money.

If you decide to look for another OS, another thing I would do is look for the biggest Ortho Practice in the area. In most places that are large metropolitan areas, they might have the city name in the practice name. I put in Phoenix Orthopedic practices into Google and got several citations. I just looked at two websites in your area from two practices where there were docs on those sites whose bio said that they did only replacements either hip or knee.

I too went through 2 OS retiring prior to me deciding I couldn’t take my knee any longer.

However your research goes and whatever decision you make, Good luck.
 

Jamie

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Poctdb offered you great advice on how to do a surgeon search. You can start to get names from our Joint Surgeon Locator (link at the top of the page). I can also give you the names of some surgeons in the Phoenix area.

As for the number of joint replacements a surgeon should do per year, we used to recommend numbers like Poctdb suggested - 200 and higher. But we have found that requirement can be difficult to attain for surgeons who are in the more rural parts of the US. Not everyone can travel to a large city and hospital to have their joint replaced. So, these days we've lowered the number to seek to something around 150 per year. There are still many great surgeons out there doing that number of joint replacements annually.
 
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pdlinda

pdlinda

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Jockette:

Thank you. I got 2 excellent replies.

Do you happen to know how I can print each one as I'd like to have a hard copy of what was suggested?
 

Jockette

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You could copy and paste the replies into an email and email it to yourself, and then print.
 
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pdlinda

pdlinda

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Jockette:

That worked perfectly! Thanks so much!

It's 114 in Phx today and I'm going to stay indoors this weekend to get this project done!
 
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pdlinda

pdlinda

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Poctdb:
Jamie:

Your suggestions were excellent.
I printed out both your posts and will spend the weekend doing research as you suggested.

I'll follow up with you early next week.

Again, thanks so much!!
 

Jockette

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I am also looking for a different surgeon. I had a Patellofemoral partial 2+ years ago that has not turned out well. I’m sure there’s a revision in my future.

I’m not just looking for an experienced revision surgeon, I’m looking for a surgeon who will also have a recovery/rehab approach that I can work with. I have a very sensitive personality and I want a surgeon next time that won’t cause me the amount of stress I had with this one.

Thankfully I meet a lot of members here on Bonesmart, some who live “fairly close to me” and I’ve been able to ask them questions about their surgeon and what his recovery approach is and what he’s like in follow up appointments. That’s important to me.

And at this point I may have found him., though his closest office is an hour and 40 minutes from me, and his hospital is about 2 hours away. In order to get an unbiased opinion on my knee for second opinions I’ve had to go a distance away.

But I think the distance will be worth it. I did have an appointment with this doctor and I liked him. At the moment he doesn’t see a need for revision, but I’ll go back to him when I need to.
 

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