Nanoknee, is it better or merely hype?

@steveinarizona Here are some reasons -
My ortho told me the robotic assistant, the training of doc and staff and all related equipment and technology take roughly 1500 operations to recoup the costs. So it is feasible in a major metro area, but a LOT of people do not live where such care is accessible,
The way health insurance ties people to specific networks, they are further limited in where they can seek care.
I recently read that nearly 2/3 of the people in the Midwest - Michigan, Minnesota, Wisconsin, Iowa, Nebraska, North and South Dakota - have "limited access" to care. In more rural states like Montana, Wyoming and New Mexico, these number can approach 80%. In states with high Medicaid coverage, travel for medical care is RARELY approved - this includes many states in the South.

"I have trouble understanding why a surgeon would do such complex surgery without a robot assistant since they are available and covered by insurance."

In response to your comment above -- the skill and experience of the surgeon is more important than whether they use a robotic assistant. I would imagine that smaller facilities may not be able to afford what can only be a very expensive piece of technology, and most likely the surgeons would have to reserve time out of their full schedules to go for some type of certification training with the equipment. Probably in time, this will become the commonplace standard, but there are many good experienced surgeons that do successful surgeries without it.

@insicknessandinhealt

Excellent points. Both Jiffy Knee and Nanoknee focus, publicly, on the method of entry and don't share any information beyond that. No information as to whether it should be done with a robot or not, what options are there for the patient (e.g., a bicruciate retaining implant), the brand of implant, whether a tournaquet is used (I suspect not), etc.

Aside from the Jiffy Knee's inventor's design of a tool, Jiffy Knee and Nano Knee are just different forms of subvastus surgery. My surgeon has been doing subvastus surgeries for at least a decade with tranexamic acid instead of a tourniquet, a CORI robot to assist him, functional alignment and Genesis and now Journey II implants. He also does revisions. I didn't do a nationwide search for a surgeon since I had Jimmy Chow right here. But I am sure there are other well qualified surgeons around the country that do subvastus methods.

My brother, in the middle of the country hinterlands, is getting his knees replaced by a well respected surgeon who is old school (uses a tourniquet, doesn't do subvastus (cuts the tendon and resews it), etc.); he doesn't have a qualified subvastus surgeon where he lives. He has had the first one done and he has had a lot of pain when he is trying to sleep since then and had significant pain from the tourniquet for the first post surgery week. On the other hand, I have a surgeon who does subvastus, uses tranexamic acid instead of a tourniquet, has done lots of cruciate retaining implants sparing both the ACL and PCL, uses a robot assistant, and has an international practice. And, most importantly, he has done hundreds if not thousands of them (Smith and Nephew has a video on its web page of Doctor Chow doing a bicruciate retaining implant with a subvastus approach at a conference in 2020). Dr. Chow's PA looked at the MRI of my knee and thought that the PCL and ACL look strong. Dr. Chow will decide if he can do a bicruciate retaining implant when he is actually doing the surgery and has the best view of the ligaments. I am hoping to get that type of implant.

I did mention to my surgeon a few weeks ago when we were just chatting that I have a friend who is scheduled to get a TKR from a Jiffy Knee surgeon. Dr. Chow said that the key is the skill and experience of the Jiffy surgeon. he asked me who and I told him Timothy Kavanaugh. He said that Kavanaugh is a good surgeon and he has not seen any problems with his work (Dr. Chow does revisions).

In general, I would avoid Jiffy Knees and Nano Knees if I have a good alternative for the very reason you state. The OP on this thread is from California. I would expect that it would not be that difficult to find a great surgeon meeting all the criteria inside the state.

@ddsack

You are correct that there are many good experienced surgeons who do successful surgeries without a robotic assistant. There is a surgeon in California (Adam Rosen) who has done a bunch of videos regarding hip and knee surgery. On one of them he explained that the rules governing bell curves applies to this type of surgery as well.

My goal, coming into surgery, is to do as much as I possibly can to be on the positive side of the bell curve, hopefully way on the positive side. In my opinion using a robotic assistant is part of that process.

I am sure that the robots are expensive. But most surgeons contract with outpatient or hospital surgical centers to use their facilities and most of these facilities will have robots. That doesn't avoid the training/learning curve/time for the surgeon but does mean that the surgeon doesn't have to purchase the robot.

If it came down to, all other things being equal, a surgeon using a robotic assistant vs. one not using one, I prefer the robotic option. But if it came to a decision between a very successful surgeon who doesn't use a robot but has done thousands of the surgeries vs. a surgeon who is using a robot but has only done a handful of such surgeries so far, I would go for the non robotic choice. I do agree that successful experience is king.

But it is possible to get all of them together although one might have to travel to find such a surgeon.

@nedclancy are you able to get on your knees

@imaginger are you able to get on your knees and if you do for how long

thanks for your view

Usually my surgeon is very busy running two operating rooms on his surgery days. Yesterday I had my TKR and the outpatient facility had only given him one operating room so he came into my prep room after the surgery preceding mine in a mood to chat (he needed to wait about an hour for the operating room to be cleaned and prepared).

We didn't discuss nano knee but we did have a brief discussion of Jiffy Knee (similar) because I have a friend scheduled for a Jiffy Knee in a few months. We were talking about the fact that Jiffy knee web sites don't talk about anything that will be done other than the method of incision. That is something that turns me off.

So we talked about the method of incision. My surgeon does and has been doing subvastus knee replacements for at least a decade and has done thousands of them. Jiffy Knee and Nano Knee are just variants of that. He is also a revision surgeon (a subset of hip/knee surgeons who do repairs and replacements of previous implants). He told me that the incision point for Jiffy is slightly better than his for the purpose of immediate and early positive recovery but he does a slight variant of that that produces a slightly longer recovery period than the Jiffy knee point but he does that in case a revision is ever needed, his angle better allows for that.

There are many variants out there. Unfortunately, it is hard for a potential patient to do research on some of these approaches like Jiffy and Nano because they don't give out much information.

For example, I know my surgeon can and does do bicruciate retaining knee implants. There is even a video of him doing one from a conference in 2020. He was planning on doing that for me If my ACC was strong enough and he couldn't make that determination until he was inside the knee. It was a late surgery and I did not see him after the surgery so I am waiting for him to let me know whether he was able to do it.

But it would be nice to know if a jiffy or Nano knee surgeon did Bicruciate Retaining implants and if so, how often. They are more complex that a Cruciate Retaining implant where the surgeon cuts the ACC and uses the implant to serve the ACC function.

@imaginger how is it now?

@sueinmn

You make some good points. My brother, in Indiana, had a knee replacement about the same time as I did. His surgeon was the most highly rated one in the area but he was a traditionalist in his approach.

My surgeon is very experienced but at the cutting edge of technology.

My brother's surgeon used a tourniquet, cut the tendon, and installed an implant. My surgeon did a midvastus entry (muscle sparing), did NOT use a tourniquet, found my ACL was strong so he installed a bicruciate retaining implant (saves and protects both the PCL and ACL). and corrected my severe misalignment with a functional alignment.

My brother is in pain and on opiods and his flex is hovering around 100. I never took a pain pill, my flex was measured today at 122 and I have essentially no pain. On day 27 post surgery I intend to be on the first tee with my regular foursome playing golf.

I think a normal knee replacement can be done by an experienced surgeon without a robot assistant. The bicruciate retaining implant requires more complex surgery than one where the surgeon resects the ACL and PCL (posterior stabilized) or resects the ACL (cruciate retaining). I don't know how reasonable it would be to do that surgery without a robot. The same thing applies to functional alignment -- it requires soft tissue work and a robot is probably necessary. However, one doesn't need to have a bicruciate retaining implant and a good surgeon can probably do kinematic alignment without a robot.