Need Recommendation for Orthopedic Surgeon for Arthritic Knees

[coffeebean]

I'm looking for recommendations for an orthopedic surgeon who specializes in arthritic knees. Very importantly, I would like a surgeon who performs total knee replacement by either the "side entry" or moves the quad muscle to the side for placement of the artificial knee joint.

Thank you in advance.

[Pinball wizard]

Absolutely, Dr Karina at UNOVA on Rolling Acres Rd. He did both of mine. No pain, and I was up and mobile the same day. Playing Golf in no time flat and then back to softball.

[valuemkt]

Before you go under the knife, examine and be evaluated for stem cell therapy

[coffeebean]

Before you go under the knife, examine and be evaluated for stem cell therapy

I looked into stem cell therapy. From what I read, it is very expensive and there is no guarantee it will be effective.

[coffeebean]

Absolutely, Dr Karina at UNOVA on Rolling Acres Rd. He did both of mine. No pain, and I was up and mobile the same day. Playing Golf in no time flat and then back to softball.
Does Dr. Karina perform total knee replacement with the side entry? If not, does Dr. Karina perform the procedure by moving the quad muscle to the side (muscle sparing procedure)?

[SIRE1]

2 years ago, I knew I needed a knee replacement and I entered a post of this Forum asking for recommendations. The replies were pretty consistent, with 3 doctors being recommended - Dr. Minh D. Nguyen, MD in Orlando, Dr. James B Duke, MD in Ocala, and Dr. Michael Messieh, MD in The Villages. After reading the comments from those who replied to my Forum post, I decided to see Dr. Michael Messieh, MD in The Villages. I was very impressed with the service I received at his Villages office, his staff was great, and I am very happy with the results from a total knee replacement.

You can look at the replies to my original post by searching "Question about Doctors performing Knee Replacements". There have been other post about doctor recommendations that you can probably review those by searching "Knee Replacement".

[villagetinker]

Stem cell surgery is not FDA approved, says a lot for the procedure.

[frose]

find someone who will do a 3d scan of the knee and have a custom prosthetic made for you.. it's much better than 1 off the shelf and it will last. used dr. petraco in miller pl. long island..

[coffeebean]

2 years ago, I knew I needed a knee replacement and I entered a post of this Forum asking for recommendations. The replies were pretty consistent, with 3 doctors being recommended - Dr. Minh D. Nguyen, MD in Orlando, Dr. James B Duke, MD in Ocala, and Dr. Michael Messieh, MD in The Villages. After reading the comments from those who replied to my Forum post, I decided to see Dr. Michael Messieh, MD in The Villages. I was very impressed with the service I received at his Villages office, his staff was great, and I am very happy with the results from a total knee replacement.

You can look at the replies to my original post by searching "Question about Doctors performing Knee Replacements". There have been other post about doctor recommendations that you can probably review those by searching "Knee Replacement".

Thank you. You have been very helpful.

[tophcfa]

Interesting thread, I had my right knee replaced 11 years ago and the left one is bone on bone and needs to be replaced. The right knee was done the old way and the recovery was long and difficult so I have been avoiding getting the left one done. I was not aware they are doing knees differently these days and you can get back to regular activities in a relatively short time period. Wishing I spent my younger years skiing the groomed trails instead of pounding the moguls, but boy was it fun at the time.

[SIRE1]

All 3 of the doctors I indicated do the surgery from the side. Actually, that is kind of misleading. When I read the forum replies, I got the impression they actually cut from the side of the knee. Actually the cut is still somewhat in the center, just a little to the left or right of center. Just not through the main muscle and tendons that go across the top of the knee. They then push those aside to get to the bones to be replaced. It supposedly reduces the amount of damage that is done.

[tophcfa]

Dam, I just did a bunch of research on minimally invasive, often referred to as quadriceps-sparing, total knee replacement surgery. It appears I am not a candidate because the knee has already had an open patella graph ACL reconstruction surgery (basketball injury back in 1994). Looks like it’s the more invasive traditional method for me. Oh well, it worked on the other knee, but it’s a long recovery. To add insult to injury, they will take out my reconstructed ACL and toss it in the garbage during the knee replacement.

[MandoMan]

Before you go under the knife, examine and be evaluated for stem cell therapy

Check out Radnothy Orthopedics in Tavares, across 441 from AdventHealth Waterman, the closest A-rated hospital to us. It’s a bit of a drive, but it may be worth it.

“ Dr Jon H. Radnothy is one of Central Florida’s most achieved orthopedic surgeons. After over 25 years of providing orthopedic care of the highest quality in Lake County, Florida, Dr Radnothy and his well regarded team at Radnothy Orthopaedics remain clear examples of how the best of cutting edge orthopedic care can be administered in a truly personal way.

Specializing in the most current and popular Joint Replacement procedures including,

Robotic Total Knee and Hip Replacement
Muscle / Tendon Sparing Knee and Hip Replacement
Custom Partial Knee Resurfacing
Computer Navigation Total Hip Replacement
Stem Cell Therapy
The nearby communities of Mt Dora, Eustis, Umatilla, Leesburg and Apopka are only minutes away. The Villages to the north and Orlando to the south are a 30 minute drive.

Voted “The Best Orthopedic Surgeon” of Lake and Sumter Counties (2018 Healthy Living Magazine).
Staff Affiliations:
Advent Health Waterman (Tavares, Florida)
Surgery Center of Mt Dora (Mt Dora, Florida)

Office Address
2051 Mayo Drive
Tavares, FL 32778”

[coffeebean]

All 3 of the doctors I indicated do the surgery from the side. Actually, that is kind of misleading. When I read the forum replies, I got the impression they actually cut from the side of the knee. Actually the cut is still somewhat in the center, just a little to the left or right of center. Just not through the main muscle and tendons that go across the top of the knee. They then push those aside to get to the bones to be replaced. It supposedly reduces the amount of damage that is done.

I was under the impression the "side entry" was a different procedure than the "quad muscle sparing" procedure. I did think the incision is actually on the side of the knee for the "side entry" procedure. Thank you for the explanation.

[mepoole]

Dr James B Duke, MD in Ocala

[Kegarn]

My husband used Dr. Steven Nguyen just this past March. His incision is on the outside of his knee cap then down the center of the leg for a bit. The muscles were moved to the side. He was up and walking almost immediately, at therapy after a week and playing golf in a month. Super recovery and very little pain.

[Villages Kahuna]

Dr. Steve Nguyen, the “father” of side entry total knee replacements. He’s probably done close to 10,000. His main office is in Orlando, but he recently opened an office on Route 44, (5555 East CR 44, (407) 355-3120 for both offices) across from Brownwood. I think he still does all his surgeries at Dr.. Phillips Hospital in Orlando.

I was “chipping and putting” in three weeks, playing a full round in five. Used a cane around the house for only a few days post-op.

[La lamy]

Absolutely, Dr Karina at UNOVA on Rolling Acres Rd. He did both of mine. No pain, and I was up and mobile the same day. Playing Golf in no time flat and then back to softball.

Wow, that's astonishing. Everybody I hear about has had 1-2 years of pain. You must have had it done before too much damage was done. Good for you!!!

[Kathryn Putt]

UNOVA. They only do hips and knees with the latest knowledge. I walked in at 8AM and walked out at 3:30PM with a new hip and only took Tylenol for discomfort.

[giorgio1948]

Dr. Cook at Advanced Orthopedic Institute 352-751-2862

[flyboyl39]

Dr. Nguyen is the only one I would recommend . I have heard horror stories in the Pickleball community about bad outcomes, revision surgeries etc. Everyone I know ( like Kahuna) that used Nguyen has had great results. I walked out of the surgery center after the procedure, walked a mile the next day , two miles the day after that and so on. I was playing competitive PB again in 5 weeks.

[tklloop]

I'm looking for recommendations for an orthopedic surgeon who specializes in arthritic knees. Very importantly, I would like a surgeon who performs total knee replacement by either the "side entry" or moves the quad muscle to the side for placement of the artificial knee joint.

Thank you in advance.
First, you mention 2 different issues you are having, arthritic knee and knee replacement. Both of those require different surgical approaches. The first thing you should do is get an MRI to determine what is actually causing you pain. An MRI will show if you need arthritis removed or if you need a partial or full knee replacement. I play sports so I went with Dr. Krueger from TOI (The Orthopedic Institute), He is a sports specific orthopedic surgeon. I liked the facility on 441,, it has the Dr. office, x-rays, MRI, Physical therapy all in one location. Dr. Krueger was great, he left a 2 inch incision that is almost transparent from my partial knee replacement. he did the surgery Thursday and I started PT on Friday am. Just remember that physical therapy is a MUST! I was back to playing sports in 2.5 months. Your doing the right thing by doing your research and asking people who have been through this for input! Good Luck!

[Cmacnair@hotmail.com]

I researched for my wife on knee replacement. She had Dr. Steven Nguyen in Orlando do the surgery. Very pleased little pain was walking same day. Much better then my knee that was done in St. Louis 2.5 years ago that still gives me pain.

[Gunny2403]

In my opinion Stem Cell Therapy is temporary and in some cases the Dr. has a vested interest in the offering. And, as noted, there is no guarantee it will work.

[jrieker68]

Dr. Steve Nguyen, the “father” of side entry total knee replacements. He’s probably done close to 10,000. His main office is in Orlando, but he recently opened an office on Route 44, (5555 East CR 44, (407) 355-3120 for both offices) across from Brownwood. I think he still does all his surgeries at Dr.. Phillips Hospital in Orlando.

I was “chipping and putting” in three weeks, playing a full round in five. Used a cane around the house for only a few days post-op.

A friend had Dr. Nguyen do hers last year. She stayed overnight the night before at a hotel near Dr. Phillips Hospital as her surgery was early the next morning.

[palasmith]

Dr. Steve Nguyen, the “father” of side entry total knee replacements. He’s probably done close to 10,000. His main office is in Orlando, but he recently opened an office on Route 44, (5555 East CR 44, (407) 355-3120 for both offices) across from Brownwood. I think he still does all his surgeries at Dr.. Phillips Hospital in Orlando.

I was “chipping and putting” in three weeks, playing a full round in five. Used a cane around the house for only a few days post-op.

Dr Nguyen is now using an ambulatory surgery center for his surgery. Location is in Orlando. I had my knee done last year and was there by 8:30 am and back in the Villages by 3:30 pm. Playing golf in 4 weeks, all sports in 3 months. I even went skiing.

[waterflower]

FDA approvals are based on corporate power first, corporate science 2nd. Remember roundup (agent orange) is FDA approved to use in the farming industry, the food you eat=cancer. Cigarettes too, with a little warning. The FDA is not here for you and I, they are a group of revolving door corporate employees who go to the FDA, cdc etc..Research the top employees in these 3 letter agencies.

[injunlee]

Dr Stevan Nguyen (pronounced Winn) at Optimotion in Orlando. Side cut, quick rehab, no pain. He did my right knee. Different doc did my left, center incision, still having issues

[BEETHOVENMIKEY]

HIGHLY recommend the Orthopedic Institute in Ocala. They have a satellite office up by Walmart on 441.
Their doctors specialize in different parts of the body.
Surgeries are done at West Marion Hospital, on Rt. 200, just West of I-75. We love that hospital over all the area hospitals.
It only takes 30 minutes to get to the doctor's offices and the hospital.
Wife and I have had our shoulders and my knee done and love their surgeons and office staff.

[LarryB]

Dam, I just did a bunch of research on minimally invasive, often referred to as quadriceps-sparing, total knee replacement surgery. It appears I am not a candidate because the knee has already had an open patella graph ACL reconstruction surgery (basketball injury back in 1994). Looks like it’s the more invasive traditional method for me. Oh well, it worked on the other knee, but it’s a long recovery. To add insult to injury, they will take out my reconstructed ACL and toss it in the garbage during the knee replacement.
I had a left knee ACL replaced in 1998. By 2015 the knee had deteriorated to the point it needed replacing. Dr Nguyen replaced it using the “side” method and never said there would be any problems due to the previous ACL work. All is still good.

[kathy1516]

My husband used Dr. Steven Nguyen just this past March. His incision is on the outside of his knee cap then down the center of the leg for a bit. The muscles were moved to the side. He was up and walking almost immediately, at therapy after a week and playing golf in a month. Super recovery and very little pain.
BE VERY CAREFUL with this technique. I had my right knee replaced this way and it went fine. The following year I had the left one replaced and it was a fiasco. In one week the pain was tremendous. The appliance had moved causing fractures on my tibia and fibula. I wore a full leg immobilizer for three months with minimal weight bearing until I could have revision. Two years after revision, the pain was back. This time I went to Shands for an opinion and the appliance had loosened and I needed another replacement. This was confirmed by another orthopod in Orlando. I had an infection in the knee which had to be removed. A spacer was placed and I was immobile again for 4 months while on IV antibiotics 24/7 for six weeks. Finally had the permanent knee placed last December. My surgery was very complex and I am still having PT today. I wouldn’t recommend the lateral approach as I had four surgeries on that knee in three years and wouldn’t wish the pain and agony on anybody.

[DOGSAREKEEPERS]

[QUOTE=MandoMan;2019580]Check out Radnothy Orthopedics in Tavares, across 441 from AdventHealth Waterman, the closest A-rated hospital to us. It’s a bit of a drive, but it may be worth it.

“ Dr Jon H. Radnothy is one of Central Florida’s most achieved orthopedic surgeons. After over 25 years of providing orthopedic care of the highest quality in Lake County, Florida, Dr Radnothy and his well regarded team at Radnothy Orthopaedics remain clear examples of how the best of cutting edge orthopedic care can be administered in a truly personal way.

Specializing in the most current and popular Joint Replacement procedures.

Voted “The Best Orthopedic Surgeon” of Lake and Sumter Counties (2018 Healthy Living Magazine).
------------------------------------------------------------------------------------------------------------------------------

I'm with you. Dr Radnothy is an excellent and down to earth doctor. My husband had his knee replaced by him and I had a meniscus tear repaired. He takes his time and explains everything.

[Baywayric]

Dr. Karl Siebuhr
Orthopedic Surgeon - Ocala, FL - Reconstructive Orthopedic Surgery - Dr. Karl Siebuhr, MD (https://www.reconorthofl.com/)
1500 Southeast Magnolia Extension
Suite 104
Ocala, Florida 34471

(352) 456-0220

Will do free evaluation visit. Uses latest 3D technology.

[gb1944]

I'm looking for recommendations for an orthopedic surgeon who specializes in arthritic knees. Very importantly, I would like a surgeon who performs total knee replacement by either the "side entry" or moves the quad muscle to the side for placement of the artificial knee joint.

Thank you in advance.

I agree with the comment about Dr Michael Messieh. He did my right knee. Quick recovery and I did not have any pain.

[Laurel Maryland]

I'm looking for recommendations for an orthopedic surgeon who specializes in arthritic knees. Very importantly, I would like a surgeon who performs total knee replacement by either the "side entry" or moves the quad muscle to the side for placement of the artificial knee joint.

Thank you in advance.
Please think twice before having any surgery in an outpatient surgi-center. If something goes unexpectedly wrong, their options to save/revive you are limited, and every second counts. Please consider having your procedure done in a real hospital, especially at our age. If famous comedian Joan Rivers had been in a hospital, instead of a surgi-center, for her procedure, she'd probably still be here today wise cracking.

[jbartle1]

First, you mention 2 different issues you are having, arthritic knee and knee replacement. Both of those require different surgical approaches. The first thing you should do is get an MRI to determine what is actually causing you pain. An MRI will show if you need arthritis removed or if you need a partial or full knee replacement. I play sports so I went with Dr. Krueger from TOI (The Orthopedic Institute), He is a sports specific orthopedic surgeon. I liked the facility on 441,, it has the Dr. office, x-rays, MRI, Physical therapy all in one location. Dr. Krueger was great, he left a 2 inch incision that is almost transparent from my partial knee replacement. he did the surgery Thursday and I started PT on Friday am. Just remember that physical therapy is a MUST! I was back to playing sports in 2.5 months. Your doing the right thing by doing your research and asking people who have been through this for input! Good Luck!

Dr. MESSIAH, no physical therapy, hip surgery, back to golf in 2 weeks.

[Notsocrates]

Stem cell surgery is not FDA approved, says a lot for the procedure.


Please explain just what exactly what FDA approval says.

[Win1894]

Sorry about the length. There is some good advice here and also some bad or misleading information that I would like to respond to having spent 40 years in the orthopedic business. I was mainly involved in a corporate R&D capacity for total hip and knee total joint devices, regularly testified to FDA panels regarding clearance of implant devices, worked with many prominent orthopedic surgeons developing state of the art implant procedures, and lastly consulted on many lawsuits against companies and surgeons regarding total joint arthroplasty failures.

Stem Cell therapies: May offer some relief on very early stages of osteoarthritis. I believe that only autogenous stem cell (harvested from the patient’s body) procedures don’t need FDA clearance, all other do and they should only follow a controlled FDA approved clinical study. If you are bone-on-bone (as determined by a simple AP x-ray), stem cell therapies will do nothing for you so don’t waste your money.

Side Approach: Over the years total joint surgical techniques have been successfully developed to reduce the amount of ancillary tissue damage (and trauma) incurred during the implantation procedure. This process has included the development of more refined instrumentation (by implant producers) available to the surgeon. Regarding total knee procedures the quadriceps muscle group were never severed. At most a ‘lateral release’ of the quads may have been performed in some more highly deformed patients’ knees in order to re-establish the proper biomechanics to the joint. Depending upon the level of knee deformity presented to the surgeon this may still be done in some instances. Mainly, it keeps the patella from dislocating laterally off the knee joint during ambulation. Anyway, over the years the surgical incision has been modified slightly to reduce ancillary tissue trauma. This results in less post surgical pain and therefore a faster recovery. Virtually all total knee systems today are placed using tissue sparing surgical approaches.

Post surgical rehab (PT): Do it, and don’t push the transition back into active sports or other highly physical activities. You will jeopardize the total joint arthroplasty. If the implants lose their fixation to the bone there is only one solution - surgical reconstruction. While the reduced pain may allow it the biology definitely favors a slow metered approach to pre-surgical activity levels. Slowly build up the musculature and other tissues spanning the operated joint. Bike riding, swimming, and walking are the best. Impact sports are never recommended by the folks that develop joint replacement devices. Every implant sold in the US comes with what is called a package insert. It contains all the contra-indications, precautions, and warnings for the device. Pre surgery have your doctor give you a copy and read it. Changing your lifestyle slightly away from competitive sports will enhance the longevity of your total joint arthroplasty. Also, to the best of your ability keep your weight down. Even small decreases in body weight reduce the stress on the total joint by a multiple of that decrease.

Painful Arthroplasty: Sometimes, even the best surgeons have patients who are subject to chronic joint pain. It’s less common than it used to be as surgical techniques and device designs have improved. Also, unfortunately, infections can occur following surgery but usually at a rate of less than 1%. They are difficult to treat and may require the removal of devices, treatment with an antibiotic laced spacer, and then total joint re-implantation after the infection has cleared.

Custom made devices: Unless you have a severe joint deformity the range of off-the-shelf sizes offered by manufacturers can successfully accommodate the vast majority of patients.

Lastly the comment by Wallflower (post #27): Utter nonsense. In the US all medical devices are cleared for sale by the FDA. This is a rigorous process of which I’ve been involved in many. There was never an easy path and all new devices including total joint devices must go through an FDA approved clinical study to prove safety and efficacy. Then the company request for marketing clearance to the FDA is scrutinized by FDA experts as well as FDA panel. The panel consists of independent (non FDA, non corporate) experts (Ph.Ds and MDs) in the field of the specialty such as orthopedics. For many devices the clinical study and clearance process may take many years. Additionally, device manufacturers are regularly visited by FDA field personnel. Their visit may take a week where they can go through all your manufacturing records and scrutinize all your quality processes to assure that you meet the myriad of requirements and standards for good manufacturing practices. If you don’t meet certain standards or are engaging in non approved practices they have the legal power to shut you down. Hope this helps. Good luck.

[petiteone]

FDA approvals are based on corporate power first, corporate science 2nd. Remember roundup (agent orange) is FDA approved to use in the farming industry, the food you eat=cancer. Cigarettes too, with a little warning. The FDA is not here for you and I, they are a group of revolving door corporate employees who go to the FDA, cdc etc..Research the top employees in these 3 letter agencies.

FDA regulations for new equipment and drugs are very strict. I've submitted many 501(k) for medical equipment for approvals to them. The equipment hospitals/doctors use "on", "in you" for "blood test results", and new pharmaceuticals must have FDA approval. The steps involved are rigorous and highly scrutinized and take years of data. Have they made mistakes? Yes. They have also kept (and removed) hundreds of substandard drugs and medical devices off the market. Among hundreds of drugs not approved, they kept Thalidomide which caused horrible birth defects off the US Market in the 60's.

[Flyers999]

I had my right knee replaced by Dr. Duke in 2018. He's the best. He did a "cementless" replacement, which he claims will last longer, although my google knowledge on this subject indicates it's too early (not enough operations performed yet) to make that claim.

In the attached pic, you see long screws, which are not normally there in most procedures because cement is used to attached the unit to the bones.

Here's a good video to watch by two surgeons from the University of Penn, so you know what you're in for.
Painful Total Knee Replacement - Why Does It Still Hurt? - YouTube (https://www.youtube.com/watch?v=pleR8NvpDZI&t=28s)

[tophcfa]

I had a left knee ACL replaced in 1998. By 2015 the knee had deteriorated to the point it needed replacing. Dr Nguyen replaced it using the “side” method and never said there would be any problems due to the previous ACL work. All is still good.

Thanks for that information. I read an article that said having a previous open surgery on the knee would disqualify a patient from the less invasive replacement surgery. It just goes to show, you can’t always believe what you read. I have a routine bi-annual appointment next week to check out my right knee replacement and I will discuss my options on the left knee with him.

[coffeebean]

Dr James B Duke, MD in Ocala

Last I heard from folks on this forum, Dr. James Duke does not perform the quad muscle (side entry) procedure for the TKR. Has he begun to perform that procedure at this time?

[coffeebean]

First, you mention 2 different issues you are having, arthritic knee and knee replacement. Both of those require different surgical approaches. The first thing you should do is get an MRI to determine what is actually causing you pain. An MRI will show if you need arthritis removed or if you need a partial or full knee replacement. I play sports so I went with Dr. Krueger from TOI (The Orthopedic Institute), He is a sports specific orthopedic surgeon. I liked the facility on 441,, it has the Dr. office, x-rays, MRI, Physical therapy all in one location. Dr. Krueger was great, he left a 2 inch incision that is almost transparent from my partial knee replacement. he did the surgery Thursday and I started PT on Friday am. Just remember that physical therapy is a MUST! I was back to playing sports in 2.5 months. Your doing the right thing by doing your research and asking people who have been through this for input! Good Luck!


Thank you.

[coffeebean]

In my opinion Stem Cell Therapy is temporary and in some cases the Dr. has a vested interest in the offering. And, as noted, there is no guarantee it will work.

I have ruled out stem cell therapy when I found out it is experimental, it is extremely expensive and there is no guarantee it will give relief of pain.

[valuemkt]

I looked into stem cell therapy. From what I read, it is very expensive and there is no guarantee it will be effective.

And you think a knee replacement is cheaper?

What guarantees will the ortho give you that the knee replacement will be totally successful and effective ?

Have you read blogs that give both sides of the replacement story ?

obviously your choice, just trying to give another option

[coffeebean]

Dr Nguyen is now using an ambulatory surgery center for his surgery. Location is in Orlando. I had my knee done last year and was there by 8:30 am and back in the Villages by 3:30 pm. Playing golf in 4 weeks, all sports in 3 months. I even went skiing.

But.......can you kneel on the knee?

[coffeebean]

BE VERY CAREFUL with this technique. I had my right knee replaced this way and it went fine. The following year I had the left one replaced and it was a fiasco. In one week the pain was tremendous. The appliance had moved causing fractures on my tibia and fibula. I wore a full leg immobilizer for three months with minimal weight bearing until I could have revision. Two years after revision, the pain was back. This time I went to Shands for an opinion and the appliance had loosened and I needed another replacement. This was confirmed by another orthopod in Orlando. I had an infection in the knee which had to be removed. A spacer was placed and I was immobile again for 4 months while on IV antibiotics 24/7 for six weeks. Finally had the permanent knee placed last December. My surgery was very complex and I am still having PT today. I wouldn’t recommend the lateral approach as I had four surgeries on that knee in three years and wouldn’t wish the pain and agony on anybody.
I am so sorry to hear of your agonizing journey with your second knee. What you described is certainly what I fear and know there is always a possibility of a failed surgery.

[coffeebean]

Please think twice before having any surgery in an outpatient surgi-center. If something goes unexpectedly wrong, their options to save/revive you are limited, and every second counts. Please consider having your procedure done in a real hospital, especially at our age. If famous comedian Joan Rivers had been in a hospital, instead of a surgi-center, for her procedure, she'd probably still be here today wise cracking.

I understand what you are saying but surgical centers are being used more and more these days, especially for endoscopy procedures. Having said that, I much prefer a hospital stay, at least overnight, for a TKR.

[coffeebean]

Sorry about the length. There is some good advice here and also some bad or misleading information that I would like to respond to having spent 40 years in the orthopedic business. I was mainly involved in a corporate R&D capacity for total hip and knee total joint devices, regularly testified to FDA panels regarding clearance of implant devices, worked with many prominent orthopedic surgeons developing state of the art implant procedures, and lastly consulted on many lawsuits against companies and surgeons regarding total joint arthroplasty failures.

Stem Cell therapies: May offer some relief on very early stages of osteoarthritis. I believe that only autogenous stem cell (harvested from the patient’s body) procedures don’t need FDA clearance, all other do and they should only follow a controlled FDA approved clinical study. If you are bone-on-bone (as determined by a simple AP x-ray), stem cell therapies will do nothing for you so don’t waste your money.

Side Approach: Over the years total joint surgical techniques have been successfully developed to reduce the amount of ancillary tissue damage (and trauma) incurred during the implantation procedure. This process has included the development of more refined instrumentation (by implant producers) available to the surgeon. Regarding total knee procedures the quadriceps muscle group were never severed. At most a ‘lateral release’ of the quads may have been performed in some more highly deformed patients’ knees in order to re-establish the proper biomechanics to the joint. Depending upon the level of knee deformity presented to the surgeon this may still be done in some instances. Mainly, it keeps the patella from dislocating laterally off the knee joint during ambulation. Anyway, over the years the surgical incision has been modified slightly to reduce ancillary tissue trauma. This results in less post surgical pain and therefore a faster recovery. Virtually all total knee systems today are placed using tissue sparing surgical approaches.

Post surgical rehab (PT): Do it, and don’t push the transition back into active sports or other highly physical activities. You will jeopardize the total joint arthroplasty. If the implants lose their fixation to the bone there is only one solution - surgical reconstruction. While the reduced pain may allow it the biology definitely favors a slow metered approach to pre-surgical activity levels. Slowly build up the musculature and other tissues spanning the operated joint. Bike riding, swimming, and walking are the best. Impact sports are never recommended by the folks that develop joint replacement devices. Every implant sold in the US comes with what is called a package insert. It contains all the contra-indications, precautions, and warnings for the device. Pre surgery have your doctor give you a copy and read it. Changing your lifestyle slightly away from competitive sports will enhance the longevity of your total joint arthroplasty. Also, to the best of your ability keep your weight down. Even small decreases in body weight reduce the stress on the total joint by a multiple of that decrease.

Painful Arthroplasty: Sometimes, even the best surgeons have patients who are subject to chronic joint pain. It’s less common than it used to be as surgical techniques and device designs have improved. Also, unfortunately, infections can occur following surgery but usually at a rate of less than 1%. They are difficult to treat and may require the removal of devices, treatment with an antibiotic laced spacer, and then total joint re-implantation after the infection has cleared.

Custom made devices: Unless you have a severe joint deformity the range of off-the-shelf sizes offered by manufacturers can successfully accommodate the vast majority of patients.

Lastly the comment by Wallflower (post #27): Utter nonsense. In the US all medical devices are cleared for sale by the FDA. This is a rigorous process of which I’ve been involved in many. There was never an easy path and all new devices including total joint devices must go through an FDA approved clinical study to prove safety and efficacy. Then the company request for marketing clearance to the FDA is scrutinized by FDA experts as well as FDA panel. The panel consists of independent (non FDA, non corporate) experts (Ph.Ds and MDs) in the field of the specialty such as orthopedics. For many devices the clinical study and clearance process may take many years. Additionally, device manufacturers are regularly visited by FDA field personnel. Their visit may take a week where they can go through all your manufacturing records and scrutinize all your quality processes to assure that you meet the myriad of requirements and standards for good manufacturing practices. If you don’t meet certain standards or are engaging in non approved practices they have the legal power to shut you down. Hope this helps. Good luck.

Many thanks for offering your expertise.

[coffeebean]

And you think a knee replacement is cheaper?

What guarantees will the ortho give you that the knee replacement will be totally successful and effective ?

Have you read blogs that give both sides of the replacement story ?

obviously your choice, just trying to give another option

When I looked into stem cell therapy, I was told insurance does not cover any part of the procedure. Things may have changed now but I did look into it about 2 years ago.

[Normal]

I had both done for 7200 using umbilical cells and it lasted about as long as a cortisone on a good day. It’s a total rip off. Save your money.

[Flyers999]

Last I heard from folks on this forum, Dr. James Duke does not perform the quad muscle (side entry) procedure for the TKR. Has he begun to perform that procedure at this time?

I specifically asked Dr. Duke whether he does quad-sparing, and his answer was yes. I don’t believe anybody cuts the quadriceps tendon anymore. Reference Win1894’s informative post(#38): “Virtually all total knee systems today are placed using tissue sparing surgical approaches.”

My scar is down the center of the knee, about two inches barely noticeable. The most important thing is that the device is the right size and in the right position, not whether you are "back" in 6 days, or 6 weeks or 6 months. I don't believe you can call Dr. Duke's procedure, "side entry," but I could be wrong.

[coffeebean]

I specifically asked Dr. Duke whether he does quad-sparing, and his answer was yes. I don’t believe anybody cuts the quadriceps tendon anymore. Reference Win1894’s informative post(#38): “Virtually all total knee systems today are placed using tissue sparing surgical approaches.”

My scar is down the center of the knee, about two inches barely noticeable. The most important thing is that the device is the right size and in the right position, not whether you are "back" in 6 days, or 6 weeks or 6 months. I don't believe you can call Dr. Duke's procedure, "side entry," but I could be wrong.

It is not only the quad tendon that I'm concerned about, it is the quad muscle. Does Dr. Duke spare the quad muscle too? I also have read comments on this site stating that you do not ever see Dr. Duke again after he performs your surgery. You only see PAs post op.

[YouNeverKnow]

Any thoughts or experience with Dr. Locker from Orthopedic Institute for knee surgery? Meniscus repair or replacement?

[blueash]

FDA approvals are based on corporate power first, corporate science 2nd. Remember roundup (agent orange) is FDA approved to use in the farming industry, the food you eat=cancer. Cigarettes too, with a little warning. The FDA is not here for you and I, they are a group of revolving door corporate employees who go to the FDA, cdc etc..Research the top employees in these 3 letter agencies.

Agent Orange : It is a mixture of equal parts of two herbicides, 2,4,5-T and 2,4-D. [contaminated in some cases with Dioxin]

Roundup : The main active ingredient of Roundup is the isopropylamine salt of glyphosate. Another ingredient of Roundup is the surfactant POEA (polyethoxylated tallow amine).

I will let the readers conclude whether your diatribe against the FDA is any more accurate than the fact that Roundup is absolutely not the same as Agent Orange.

[Smalley]

BE VERY CAREFUL with this technique. I had my right knee replaced this way and it went fine. The following year I had the left one replaced and it was a fiasco. In one week the pain was tremendous. The appliance had moved causing fractures on my tibia and fibula. I wore a full leg immobilizer for three months with minimal weight bearing until I could have revision. Two years after revision, the pain was back. This time I went to Shands for an opinion and the appliance had loosened and I needed another replacement. This was confirmed by another orthopod in Orlando. I had an infection in the knee which had to be removed. A spacer was placed and I was immobile again for 4 months while on IV antibiotics 24/7 for six weeks. Finally had the permanent knee placed last December. My surgery was very complex and I am still having PT today. I wouldn’t recommend the lateral approach as I had four surgeries on that knee in three years and wouldn’t wish the pain and agony on anybody.
I am so sorry to hear about your suffering. It is kind of you to share your story with others as a word of warning.

[Flyers999]

It is not only the quad tendon that I'm concerned about, it is the quad muscle. Does Dr. Duke spare the quad muscle too? I also have read comments on this site stating that you do not ever see Dr. Duke again after he performs your surgery. You only see PAs post op.

I too only saw Dr Duke once, before the operation, which I didn't mind. It was no biggie for me.

Maybe someone can tell us if Dr Nguyen personally sees patients after the operation?

Dr Duke is very popular, a superstar. On the morning of my operation, I was the first of the day, I looked up on the schedule board and noticed he had seven operations that day. And he operates three days a week. For months after the pandemic shutdown he went to four days per week. He does hips too which are not as hard as TKR.

When I decided to have a TKR, I narrowed it down to either Duke or Nguyen. I initially chose Duke because he had fewer negative reviews, I'm glad I did.