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-   -   Need Recommendation for Orthopedic Surgeon for Arthritic Knees (https://www.talkofthevillages.com/forums/medical-health-discussion-94/need-recommendation-orthopedic-surgeon-arthritic-knees-325436/)

coffeebean 10-22-2021 11:24 AM

Quote:

Originally Posted by palasmith (Post 2019647)
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 10-22-2021 11:35 AM

Quote:

Originally Posted by kathy1516 (Post 2019692)
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 10-22-2021 11:38 AM

Quote:

Originally Posted by Laurel Maryland (Post 2019719)
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 10-22-2021 12:46 PM

Quote:

Originally Posted by Win1894 (Post 2019760)
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 10-22-2021 12:52 PM

Quote:

Originally Posted by valuemkt (Post 2020118)
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 10-22-2021 04:31 PM

Say NO to stem cell
 
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 10-23-2021 04:40 PM

Quote:

Originally Posted by coffeebean (Post 2020114)
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 10-23-2021 05:40 PM

Quote:

Originally Posted by Flyers999 (Post 2020683)
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 10-24-2021 08:11 AM

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

blueash 10-24-2021 08:55 PM

Quote:

Originally Posted by waterflower (Post 2019664)
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 10-25-2021 08:43 AM

Quote:

Originally Posted by kathy1516 (Post 2019692)
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 10-26-2021 08:51 AM

Quote:

Originally Posted by coffeebean (Post 2020707)
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.


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