Nanoknee, is it better or merely hype?

@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.

@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.

@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.

@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?

@dinalud
Thank you for your encouragement. Right now the challenge is finding a surgeon who is willing to work with this condition. It can be caused by leaking blood veins in the knee in which embolization helps. I've had that but it did not help. It can also be caused by the synovial lining inside of the knee having problems, but that can't be seen very easily. I am trying to find a surgeon who does arthroscopic surgery, with a tiny little camera, then if they see the problem with the synovium, it can be removed and will grow back later. This is a fairly new surgery that not many doctors can do, or are willing to. I have found two surgeons in Portland that can do this and one is willing to meet with me in January. Wish me luck!

@catheem
Jiffy knee and Nano knee use a subvastus method. My surgeon used a midvastus method and the 12 hour nerve block. My surgeon is incredible and after the nerve block wore off I still had no meaningful pain. 21 days post surgery and I was measured with my flex being 122. Then I went to my golf club and tried hitting some balls on the range. I swung very easy but I could hit the ball and I will be playing with my regular foursome on Tuesday which will be 27 post surgery.

Jiffy and Nano are marketing gambits but they do work well for non problematic cases. My surgeon said he used the midvastus method instead of the subvastus method for two reasons: (1) he is leaving a path for any future revisions should it become necessary; and (2) He was doing a bicruciate retaining implant (BCR) and a functional alignment (I was severely misaligned) and these two require more complex surgery and the midvastus approach gives him a wider field to work in.

The subvastus approach goes under the tendon and muscle; the mini midvastus approach goes through the muscle fibers and also skips the tendon. The subvastus approach gives slightly less pain than the midvastus but both are way superior to the traditional approach which cuts both the muscle and tendon and then repairs them at the end.

My surgeon is an engineer by training and is the principal inventor of the Superpath method for hip replacements and has a number of patents. Nonetheless, he says (and I agree) that the most important qualification is extensive experience doing the exact same procedure. I would look for at least several hundred such procedures. If a surgeon had been doing traditional hip surgery, had recently moved on to Superpath but had only done 15 of them so far, both my doctor and I would rather have that surgeon use the traditional (most likely painful) method because he is not extensively experienced on the Superpath method.

So go ahead and check out the Jiffy and Nano surgeons. For example, there is a Jiffy knee surgeon in my area that has extensive experience. My surgeon is also a revision surgeon (he spends about 20% of his time revising others' work) and he told me that he has not seen anything bad out of this Jiffy doctor. That is a compliment.

At the end of the day, there is still an element of chance involved. But selecting the right surgeon can significantly improve your chances of getting a good recovery.

For whatever it is worth, here are my surgeon requirements:
(1) subvastus or midvastus approach
(2) BCR implant (95% of knee surgeons remove the ACL and a large proportion also remove the PCL. They then let the implant try to serve the function of those ligaments. A BCR retains both ligaments. So after surgery I still have all my ligaments and they are working. But the surgery for doing this is more complex.
(3) Modern alignment repair meaning NOT mechanical alignment (which was always the gold standard and is now fools gold). Preferably Functional alignment but kinematic or inverse kinematic would be okay.
(4) NO routine use of a tourniquet
(5) Extensive experience doing the above
(6) great mind
(7) Great hands.

I found someone who met all 7 of these. But if you can't, #5 is the most important.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4105775/).

@steveinarizona
Thank you for that info.
I'm curious how you are so well informed with what you wanted in your list, such as subvastus vd midvastus, BCR, tourniquet use, functional vs kinematic alignment etc--these were not on my radar when doing research, questions I would not even know to ask. . Do you mind sharing how you knew about all these fine details? By the way, I really appreciate and am benefiting from your knowledge. Thank you for sharing it with us.