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Nanoknee, is it better or merely hype?
Unfortunately, I have been diagnosed with arthritus in my left knee and told that it will eventually need a TKR. I have a friend who has had both knees replaced and heard horror stories about how painful it is. Searching the web I found a site (nanoknee.com) that claims that there knee replacement method is faster, better and less painful. Is this true? It seems that if it were better it would be used more often than titanium replacements. Supposedly it has been used for 10 years so there must be patients who have undergone it. Any advice would be helpful.
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@wisco50 What qualifies as a 'custom joint?' Thank you.
It used to be that joint replacement parts came in “stock” sizes, i.e. for knees that would be Small,Medium or Large. Same back then for hip replacements. This was apparently decided/chosen by surgeon. S/he would also choose what company made the replacement they were going to use. Replacement joints can be made by different companies/manufacturers. We would see that on the OR schedule as a name, for example Stryker is a brand name. Surgeons often had preferences for which brand they liked working with the best though I would think they might opt for what they thought might work best in that patient (at least I hope so!).
Now a surgeon can order a CT scan of the preop patient’s joint (used to be CT when I worked) then that CT scan is somehow turned into what is commonly referred to as a CAD = computer assisted design and a model is made from that. In my case (2009) the process took several months, was sent to surgeon for pre approval and then “finished” as in polishing, etc.
Most joints are combos of some artificial product (not plastic but in that concept) and titanium. I was told that the joint got its super smooth shiny surface from the addition of some nickel added in with titanium.
I told my surgeon that I am highly allergic to nickel every time it’s been in contact with my skin so he had mine made completely out of titanium, metal wise. If patient is unsure they will do testing preop.
Hopefully this makes sense? Custom is the way to go for many orthopedic surgeons. Betting insurance companies don’t like it but I am sure we pay for it somehow! 🙄
@wisco50
As you note there are many options. My surgeon uses Smith & Nephew Journey II implants. They are premade but are allegedly biocompatible as they are made of oxidized zirconium. The literature is split on custom vs. standard implants.
There are limitations on a custom implant. For one, Conformis (the custom company) does not make a BCR version -- only CR and PS versions. I wanted a BCR and my surgeon does many of them and gave me one. That means that both my ACL and PCL were retained and supported by the implant.
The fact that a pre-surgery CT scan must be used to make the implant also means that there is no ability to make modifications to the plan once the knee is opened up. Like everything in life, there are compromises that must be made for every choice.
I believe that surgeon selection is key. Determine the key features you want (in my case minimally invasive approach and a non mechanical alignment correction) and then find the very best surgeon you can.
My surgeon was an engineer before he was a physician and he is the primary inventor of the Superpath minimally invasive method of performing a hip replacement. He has more than 15 patents. Despite this, he believes that extensive experience doing the particular procedure is the single most important criteria. So do I.
Ultimately, this is what I wanted in a surgeon:
1) subvastus or midvastus method;
2) Does not routinely use a tourniquet;
3) can and is willing to do a BCR;
4) corrects my alignment with a Functional alignment (or at least a kinematic/inverse kinematic alignment);
5) HAS PERFORMED THIS PROCEDURE MANY, MANY TIMES (AT LEAST A HUNDRED);
6) Has great hands;
7) Has a great mind
I think I found all of that in my surgeon. A BCR is very rare and is a procedure where both the PCL and ACL are preserved and protected. My surgeon has been doing BCRs for many years and I even found a video of him doing one back in 2020 for an orthopedic innovations conference.
My surgeon met all of these goals and he replaced my left hip about three years ago and my right knee about 2.5 months ago and I had zero post surgical pain each time. My surgeon's approach to knee replacement surgery is to be a couch potato the first week, then begin some activities around the house, and commence PT in the third week. That week my PT measured my ROM at 122.
So my advice is to put all your effort into finding and securing the best possible surgeon.