Best Practice Health TV
Recent advances in robotic surgery and minimally invasive approaches have made Total knee replacement better and less painful. However, it is not for everyone. Read our blog article where I will help you figure out if you have tried everything else first, show you how to take a survey to know if your condition is bad enough for TKR (Total Knee Replacement), go over the surgery and rehab to help you decide if surgery is worth it for you, and finally, if it is the right time. I will show you ONE thing you need to do to get the best new knee for you.
There are not that many complications from knee replacement surgery. I graphed the most common ones here. The size of each block is in proportion to how often the complications occur. While rare, deep tissue infection, shown in blue in the upper left corner, is one of the most common. Sadly, infection is also one [...]
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The stakes for having a total joint replacement are high for everyone—you only get one chance to have it done right the first time. For young people with congenital hypoplasia or post-traumatic arthritis, the stakes are even higher. Errors in the placement or defects in components of your new joint may show up slowly over [...]
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Welcome back. I’m Dr. Dan Lieberman, your host on Best…
read moreBut how do you know if it is right for you?
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The most impactful thing you can do to ensure you have a good outcome from knee replacement surgery is to pick the right surgeon.
Robotic assistance assures you are getting the best total joint replacement available today with a personalized surgical experience. For the Stryker robot the process begins by obtaining a high-definition CT scan of your knee. This will be uploaded so the robot’s computer can construct a 3D model of your knee. The model will be used to help select the implants which will give your knee the best possible range of motion once implanted. During surgery the robot also assists to give your surgeon superhuman accuracy while removing the diseased bone.
We’re committed to solving your knee pain problems with the least invasive treatment possible.
We use the robot on every knee surgery, which means a personalized implant selection that results in a better outcome.
We utilize the only implant that’s approved to last for 30 years.
No hospital stay means a much lower risk of infection.
Partial knee replacements are half the surgery and recovery time of a total knee.
Preparing for total knee replacement surgery is easy. Three months before surgery make sure you stop smoking and begin a well-balanced diet. Ten days before surgery be sure you have a plan for stopping any blood thinner with your primary care doctor or surgeon’s office. Prepare your home with 7 days cooking and cleaning done and ready before surgery. One of our nurses will call and review your medical fitness for surgery a couple days out. Be sure and ask them any questions you have about your home or medications on the day of the knee replacement. Stop eating and drinking at midnight before surgery. The operation is done under a spinal, but you will need a ride home after the procedure.
Total knee replacement surgery is done under in our ambulatory surgery centers, so hospitalization is not required. By having your surgery in an ambulatory center, you avoid hospital errors, have a lower risk of infection with COVID-19 as well as in your new joint. The anesthesiologist typically performs a spinal anesthetic, which enables you to take your first steps within 90 minutes of the knee replacement surgery, and to actually walk out of the surgery center yourself. Walking right after surgery reduces to the point of eliminating the risk of developing blood clots in your legs which can be fatal if they go to your lungs. That means having ambulatory surgery is not only less painful, but it may also save your life.
The recovery after minimally invasive total knee replacement in much shorter than for the traditional surgery. While every patient is given a walker when they leave the surgery center, most no longer use them to assist in walking 1-2 days after their minimally invasive robotic assisted knee replacement surgery. Home exercises shown in a video series by our own
Most patients are ready to return to light duty work 1-3 weeks after knee replacement, moderate duty 3-6 weeks later, and heavy duty after 12 weeks.
Once fully recovered from minimally invasive robotic-assisted knee replacement patients are extremely satisfied and have no permanent restrictions.
You should do 3 weeks of physical therapy before considering an MRI—studies show worse results if you get imaging at this point. If you are not better after 3 weeks of therapy, then (6 weeks since the pan began) you should get an MRI and referral to a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management. They will do a medial branch block and radiofrequency ablation as appropriate. Don’t let anyone talk you into epidural injection; that is not what you need.
You should do 3 weeks of physical therapy before considering an MRI—studies show worse results if you get imaging at this point. If you are not better after 3 weeks of therapy, then (6 weeks since the pan began) you should get an MRI. We can help you find a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management who doesn’t over-prescribe dangerous narcotics.
They will offer you medial branch block and epidural injection. Those don’t really work for this problem. Your options are (off label) intradiscal injection of stem cell-derived growth factors, denervation with the relevant procedure, and then referral to a spine surgeon for interbody fusion if those fail.
You need an MRI now and referral to a spine surgeon for possible laminectomy decompression surgery. We can help you find one who is board-certified and specializes in minimally invasive surgery.
You need an MRI now and referral to a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management. Don’t go to one that prescribes a lot of narcotics, they may get you killed. If you’re not better after 3 epidural injection you will be referred at 12 weeks to a spine surgeon to consider microdiscectomy. Note that you DO NOT need radiofrequency ablation; so, don’t let anyone talk you into a medial branch block.
This stuff can be confusing. Don’t sweat it. We’ve got you. Your MRI came with a report by a radiologist which describes the findings. If you don’t have a copy of your report, you can get one from the imaging center where the x-ray was taken. The doctor who prescribed the MRI has a copy as well. Find the section labeled Impression. First, under the impression, look for the word normal. If you see something like “Normal MRI of the hip then you are done. You do not need to check anything.
Next, search the impression section for the words osteonecrosis or avascular necrosis. If you see either one in the report, then ignore the rest of the report and check the osteonecrosis box. If neither of those is in the report, ignore the rest for now and continue.
This stuff can be confusing. Don’t sweat it. We’ve got you. Your x-ray came with a report by a radiologist which describes the findings. If you don’t have a copy of your report, you can get one from the imaging center where the x-ray was taken. The doctor who prescribed the x-ray has a copy as well. Find the section labeled Impression.
First, under the impression, look for the word normal. If you see something like “Normal x-ray of the hip then you are done. Check the box normal. Next, search the impression section for the word hypoplasia. If you see hypoplasia in the report then ignore the rest, and check the hypoplasia box.
If you are still going, then look for the word arthritis. The radiologist should have given the arthritis a grade from 1 to 4. If you see arthritis in the impression section but there is no grade, then look at the rest of the report for a grade 1,2,3 or 4 and check the appropriate box. If there’s no grade then you have every right to call the imaging center and ask them to have the radiologist to do their job and redo the report with a grade.
Not all orthopedic surgeons are the same. You deserve the best. That means a surgeon who is
In my experience less than 10% of orthopedic surgeons meet all five of these criteria. That means if you go to the surgeon you’ve been seeing, or the one recommended by friends or family, there’s a 90% chance you will not be getting the best.
At Phoenix Spine and Joint we make it our business to know the best. Call us for help finding the best surgeon near you who takes your insurance and is accepting new patients.
If you have any of the following red flags you need to see a doctor NOW!
Radiculopathy. This condition is most often due to herniated disc, but can also be caused by bone spurs, or compression of nerve roots as they leave the spinal canal. The traditional treatment is to confirm the herniation or compression by MRI, followed by a trial of epidural injection, with microdiscectomy or laminectomy surgery if all else fails.
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Facet syndrome. Your low back pain is most consistent with arthritis. Look for confirmation on your x-ray and MRI reports with discussion about “arthritis.” The traditional treatment is radiofrequency ablation done by a pain management physician.
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Discogenic low back pain due to an annular tear. Sorry, this is the least common and the hardest to treat. Traditionally, the recommended procedure is fusion; however, that does not always work and causes adjacent level issues. More recently a denervation procedure was approved called the Intercept procedure from Relievant. Some doctors recommend injection, The two options are stem cell-derived growth factors, and ozone.
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