Nanoknee, is it better or merely hype?

@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.

@steveinarizona I would love to hear how it went for you. I hope well. I have been to see Dr.K in Scottsdale for Jiffy Knee and have it scheduled but have had some concerns with his office and communication. I'm guessing he was your surgeon? Hope your recovery is going great.

@dinalud

Mine went great. My surgeon was Jimmy Chow who had complimented Dr. K when I told him I had a friend scheduled to have a TKR with him.

Dr. Chow did a mini midvastus entry, did not use a tourniquet, did a Journey II XR implant procedure (a bicruciate retaining implant so I kept my ACL and PCL), did a functional alignment to correct my severe misalignment and then did a plastic surgery close.

I had zero post procedure pain. My surgeon's protocol is to be a couch potato for the first week, then begin a few activities around the house, and commence PT in the third week (he has been doing this for some time before the HSS Quiet Knee protocol was announced). During that first week of PT my therapist measured my ROM at 122. On day 27 after surgery, I was playing golf.

If I had to do it again I would do it with the same surgeon. But be aware..he has withdrawn from Medicare and insurance. If paying his fee (less than a Nano Knee fee) is not doable, then Dr. K is a viable alternative.

I have some additional information that may be helpful. First of all, regarding Jiffy Knee, in a FB Live Dr. Kavanaugh did last year he said that of all the surgeons trained in Jiffy Knee he is the one that has the most experience with it. He had only been doing it himself for about a year at that time. He did do traditional TKR's for many years prior, but his experience with Jiffy Knee, and thus by extension other JK surgeons is not very long. . Secondly, per several surgeons I have spoken with, Jiffy Knee, markets itself based on muscle sparing, minimally invasive approach as if it is something new and innovative, when in reality it has been around for decades and is used routinely by many surgeons. Also noted was that robotics is crucial to use with muscle sparing because the muscle sparing approach alone does not give the surgeon a good enough view of the knee during surgery to ensure precise alignment . Because of this, one TKR surgeon who is very familiar with Jiffy Knee, knows Dr, Kavanaugh and is also a nationally recognized expert and instructor of other surgeons, said that because of this, what many don't know is that there are many revisions needed of Jiffy Knee. He said not even the JK surgeons know this because their patients go elsewhere for the revision. Short term outcomes may be good, but there is not a lot of data about longer term outcomes with JK. As was mentioned in another post, TKR is a complex multi faceted process with many important factors integral to its success, so marketing approaches that emphasize just one aspect such as muscle sparing can be misleading. And also as has been mentioned, the skill and experience of the surgeon is key--but this is not so easy to verify IMO. I will do a separate post on Nanoknee which I have also done research on and have had some experience with.

@steveinarizona Thank you for that info. Wow! that is amazing and great to hear! I am very aware of Jimmy Chow and had checked in to him -he is known to be tops in his field, but I had been discouraged by the out of pocket cost due to his not taking insurance. With no pain and good ROM prior to starting PT,, what kind of care or help did you need post surgery, if any? I wish I'd read your post sooner--I just had my TKR done in another state and did not have as good a post op experience as you. My ROM at week 4 was still at 90 and there has been pain for sure. I had a friend caring for me for 2 weeks post surgery and I could not have done it without her. I posted above some info about Jiffy Knee and Kavanaugh before reading your post. Also with Kavanaugh, I had some pretty unpleasant experiences with his staff- the scheduling person specifically- I thought she was very rude, and some concerning communication issues. I know a lot of people rave about him, but I wonder about long term outcomes and so still have some question marks in my mind about him. The fact that Chow endorses him is significant though.

@dinalud
I admire you knowledge of knee surgeries. My 3-year-old TKA seems to be a failure. Can a jiffy knee be done to correct it?

@bjw1948 I'm so sorry to hear that. Where did you have it done? I really don't know if a Jiffy Knee can correct it or not, especially since as I mentioned in my post, I've heard from a surgeon that Jiffy Knees frequently need revision. I did very extensive research, but there is a lot to know and hard to know what or whom to believe because there is so much info out there. I think most people probably don't even know what to ask and just believe whatever a surgeon tells them, because how would we know otherwise? It's great to have a forum like this where this can be discussed. I wish I knew what to tell you about your revision, but I really don't. I think I would keep digging to find surgeons who are good at revisions. Where are you located? What has gone wrong with yours?

@wisco50 what you describe as custom with the CT scan and CAD and model is what Nanoknee markets itself as doing , and charges $8500 out of pocket for this custom design. I wasn't aware anyone else was doing this. May I ask where you had it done and where it is done? Also, another surgeon who had some inside info on Nanoknee through a doctor he knew who went to train with them , said that often what happens with Nano knees is that the custom implant is found not to fit once in surgery, so an implant from off the shelf is used (whether they reveal this to the patient who has paid $8500 out of pocket for the custom fit I don't know.) Also when I had a consult with Dr. Ferro the NanoKnee founder, he said that the process took several weeks, and yet when I went to schedule it, they wanted me coming to CA two days prior to surgery to have the CT scan so they could have it ready for surgery two days later. When I asked the scheduler about this, she said oh yeah, they can make it really fast. Sounded very questionable to me. There were also some other very questionable experiences I had with them as well which planted enough doubt in my mind that I cancelled surgery. The surgeon I mentioned called Nanoknee an out and out scam.