Lateral Approach Total Knee Replacement

@portstlucie

I would attribute your problems to your surgeon, not the "lateral approach". My surgeon used a mini midvastus method, did not use a tourniquet, installed a bicruciate retaining implant, used a CORI robot for fine precision, fixed my severe valgus misalignment with a Functional alignment and did a plastic surgery close.

I had zero pain after the total knee replacement. My surgeon's recovery protocol is to to be a couch potato for the first week and then begin small activities around the house in the second week and commence PT in the third week. The concept is to reduce the swelling before starting PT. That week my PT measured my ROM at 122.

Some of my success may be luck but I attribute most if it to the magician who did the procedure. By the way, my surgeon does about 20% of his surgical work doing revisions of other surgeons' work.

@steveinarizona I am 3 years out from a TKR, front incision, Zimmer Inplant and still in horrible pain! Two second opinion orthos said everything looks fine, one said it seems fine but with so much pain it is clearly not fine for me and suggested a revision. I would want to consult with a revision specialist; who is your doctor?

Dr. Jimmy Chow. But be aware that he does not take insurance nor medicare. For my TKR the fee was $5,500 and the rest was covered by insurance.

@steveinarizona

I have saved your reply for the next TKR I’ll have. While my surgery went well and I recovered about the way I thought I would, and I returned to most of my activities, I’m intrigued with your story and procedure. I am 5 years out of my TKR and I think I’ll need manipulation again, worried I won’t have the strength to get the other knee done with this scar tissue. I’ll be bringing your note with me to my surgeon. BTW-your doc’s recovery protocol sounds like common sense perfection.

Thanks to all for your posts and experiences.

I am 2 years post TKR with a lot of inflammation, swelling and severe pain. Surgery was to correct OA with calcified meniscus, etc. and 'typical' vertical incision , mechanical alignment with Zimmer Persona cruciate implant with tourniquet. (See link re: use of tourniquets especially the conclusion for no comorbidity issues)

The diagnosis for my current symptoms is 'instabilty' however not one surgeon out of 5 consulted can find anything wrong with the implant or soft tissue. Most pain is along lateral side. I believe there is nerve damage which I am working on.
I had a revision with new semiconstrained insert installed which did not help and recent RF nerve ablation which was also unsuccessful.
My surgeon suggests a full revision but cannot tell me what is wrong with current implant. He also tells me that it may not fix the knee and it could be worse! Yikes! Not going down that road.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10386593/

I have had 4 joint replacements. Both hips were done using the anterior approach which was relatively new in 2010. I learned about lateral approach to knee replacement today and the same process of innovation slowly becoming the new revolution seems to be happening now. I am on a reservation list for Mayo Jacksonville but they have appeared to have lost my contact. I hope someone will get back to me. Sharing experience like this is quite valuable. I recently gave up swimming as my major source of exercise after 45 years. I just turned 79 and began walking and weight training. I hope to push back on the challenges of chronic arthritis and spinal stenosis. All the best!

I just heard about this from a friend whose husband is considering knee replacement. I live in NYC where there are 2 specialty hospitals: Hospital for Special Surgery and NYU Hospital for Joint Diseases. I could not find any “Jiffy” trained surgeons. Seeing my hip surgeon next month. Will ask him. He does knees too.

@xteach

While my surgeon has been using this recovery protocol of rest followed by PT for some time, it was recently endorsed and adopted by the best orthopedic hospital in the US: the Hospital for Special Surgery:
https://news.hss.edu/hss-research-shows-quiet-knee-protocol-could-redefine-knee-replacement-recovery/
So there are already some surgeons using this protocol and I suspect more will in the future. However, I would not make my decision about a surgeon based solely on this issue and if my surgeon wanted me to start PT right away, and I had concluded he was my best option otherwise, I would go with him and I would follow his instructions.

@dbduffer

One needs to read a paper like this carefully. note the caveats:
"This study was not without limitations. First, outcome measurement was continued for only 8 weeks postoperatively; however, as the aim of the present study was to investigate the effects of tourniquet use on early recovery after TKA, we deemed this period to be sufficiently inclusive. Second, tranexamic acid, which is commonly used in current arthroplasty practice was not included in the present study because it was not used in any of the patients in this study. Third, preoperative psychological evaluations were not conducted for the patients in this study, which is a deficiency in terms of postoperative pain management. Fourth, the data are nearly one decade old and some developments took place in surgical techniques. Finally, the sample size was small and insufficient to observe an adequate number of complications, and the study participants were from a single orthopedic center. Further multicentric studies with a greater number of patients are needed to confirm the findings of the present study."

The standard of care for no tourniquet use is the use of tranexamic acid. Concluding that tourniquets are better compared to non tourniquets in a study where the non tourniquet users were not using the standard methods is useless. My surgeon did not use a tourniquet and my surgery came out great but he definitely used and had me using tranexamic acid.

It is akin to comparing a steak sandwich to a hamburger and claiming that the hamburger is better because it spreads the heat more evenly.

I don't quibble with the conclusion if one accepts the caveats. But I don't know of any surgeon who does not use a tourniquet but also does not use tranexamic acid.

@crankyknee
Jiffy knee is a branded version of subvastus. These are two great orthopedic hospitals. For a knee replacement, I would choose the Hospital for Special Surgery and a number of their surgeons do subvastus or midvastus procedures.