Nanoknee, is it better or merely hype?

I am glad you are so happy with the results. When I discussed with him before my surgery the type of method he would use he said it was mid vastus. He explained that subvastus would be slightly less painful but mid vastus gave him a better field of work and if a revision were necessary, a pathway for that revision. It appears from your post that he was able to fix your scar. He also did a plastic surgery close for me.

You are right that he is very approachable. I just had my six month review with him (Dr. Chow, not his PA) and he told me I had no limitations. I asked if that meant I could go on trampolines with my grandkids; he said yes. I asked if that meant I could run; he said if I wanted to.

I had to wait a bit for my surgery not only to get on his calendar but his calendar was frozen for a bit as he was recovering from rotator cuff surgery caused by a skateboarding accident. That is my kind of surgeon. I asked him who his surgeon was and he told me. One of my golfing partner's wife is having shoulder surgery on Thursday from the same surgeon who did Dr. Chow. I believe that asking physicians who they and their immediate family use is a great method to identify great doctors.

One warning for others. Dr. Chow has withdrawn from Medicare and does not generally take insurance. I am on a Medicare Advantage PPO plan (probably one of the best such plans) and the rest of the cost of the procedure was covered by my insurance; just not his fee.

I have been trying to figure out why he is so good when others do similar procedures and their patients have pain. I think it comes down to great hands and a great mind. Once the surgeon opens up the knee he has to make the tibia and femur cuts to hold the implant and resurface the patella and move it out of the way. I suspect there is artistry in exactly how that is accomplished. The patient problem is how does one find out which surgeon has great hands and a great mind. I have no answer for that other than inferring it from what you can gather.

I have a friend who is scheduled to have a "Jiffy Knee" done in Scottsdale. I was curious and one day when I was chatting with Dr. Chow I mentioned it and asked him what he thought. He replied that it depended on the skill of the surgeon. I told him the name (Timothy Kavanaugh) and Dr. Chow said he has seen no problems from that surgeon's work. That is a compliment as Dr. Chow spends about 20% of his surgical time doing revisions of other surgeons' work. A great surgeon is not afraid to praise another.

I am very happy that you have had such a great outcome.

@steveinarizona You're exactly right ... great hands and great mind. A surgeon needs to be precise and not all are. In January 2023, I had 2 meniscus tears repaired on my right knee. Almost a year after my ski accident. I struggled to walk after and this surgeon told me it was due to all the scar tissue that had formed. He said he could go in and remove it, but it would just form back. I was walking on 2 crutches at that time, very slowly. I looked at him and holding back tears asked him, "So, this is going to be the rest of my life?" He said, "I don't know what to tell you." Then I was scheduled to go to Lithuania for a Patella Femoral Replacement. A portion of the cost would have been covered by Alberta's healthcare system IF I could get a letter from a surgeon stating there was no one who could perform that surgery. I went to the surgeon who did surgery on my meniscus for this letter. He laughed at me and said he couldn't write that letter, because he can do that surgery, but he wouldn't do it on me, because I would be worse off. What went through my mind, but I bit my tongue, 'in other words, you say you can do the surgery, but you don't do it, because you don't do it well, so technically, you don't perform that particular surgery.' Another orthopaedic surgeon explained the process and you must be exact when making the angular cuts to the femur. There is no room for any error. Good hands are needed and the surgeon's attitude to be the best at their practice. Dr. Chow has both attributes.

@sheliae
Mostly but not entirely. My surgeon could tell from the x-rays that I appeared to have arthritic results in all three compartments BUT he said he would check once he opened me up and if he could do a partial instead, he would. He said he keeps a full complement of partial and full implants in the operating theater.

So it is possible that he would do a partial for me without knowing for sure before hand. But that should be part of the pre-surgery discussions with the surgeon.

If you really want the best, I would suggest coming to Phoenix to see my guy -- Jimmy Chow. He has an active travel practice. He is the primary inventor of the Superpath method of minimally invasive hip replacement and he did my left hip four years ago. I had no post surgery pain. My right knee failed a little over a year ago and he replaced my right knee. Once again, no pain post surgery.

The caveat on Dr. Chow is that he does not take insurance and has withdrawn from Medicare. I had to pay his fee directly to him but the rest was covered by my Medicare Advantage PPO plan. Amazingly, his fee is less than the Nano Knee fee.

I had constant but manageable pain in my right knee before surgery. But I was also severely misaligned (valgus) and if I stepped the wrong way an extremely sharp pain ran down my leg. Presumably a nerve impingement. I also had ankle pain and even went to a foot/ankle surgeon to confirm that it was referred pain from the knee.

I was not afraid of the surgery. What I was afraid of was general anesthesia. I confirmed that his regular practice was a spinal with a temporary nerve block but I also confirmed that when I met with the anesthetist before the surgery. I was his last surgery of the day (another story) and I was still home before dark.

Dr Chow did a mid vastus cut and did NOT use a tourniquet. He had initially determined from the MRI that my ACL and PCL were intact and strong and told me that it appeared that he could do a bicruciate retaining implant (BCR). In 99+% of all TKRs the ACL is removed and in a substantial portion the PCL is removed as well. in a BCR, the ligaments are retained and protected. But it is more complex surgery and very, very few do it. Dr. Chow is one of the very few who not only do it but does it regularly. There is even a video of him doing the exact procedure for an orthopedic innovations conference in 2020. Very few manufacturers of implants even have a BCR version. Dr. Chow did a BCR for me so post surgery I still have all my ligaments.

I have a bunch of criteria for a knee replacement surgeon. Dr. Chow satisfied all of them:

1) Uses a minimally invasive method -- subvastus or midvastus;
2) Does NOT use a tourniquet;
3) Uses a robot to assist him;
4) Does a Functional alignment to repair my misalignment. A kinematic or inverse kinematic alignment would have been acceptable but not the traditional mechanical alignment;
5) HAS EXTENSIVE EXPERIENCE DOING THE EXACT PROCEDURE THAT HE WOULD DO FOR ME;
5) Has great hands; and
6) Has a great mind.

I have been trying to figure out why my procedure went so well and others not so much even though they may have done much the same procedures. I have now tentatively concluded that the answer lies in #s 5 and 6 above. Images can give guidance and help the surgeon build a model implant but exactly where to cut and how much is still an art form. That is where great hands and a great mind come into play.

Before my surgery I told Dr. Chow that I wanted to be back on the golf course by the end of four weeks. He replied that it was an aggressive target but he was up to it if I was. I was. He was. On the 27th day after my surgery, I was playing golf.

I am an 81 YO male. I recently had my six month checkup with him. He told me I had no limitations. I asked if that meant I could go on trampolines with my grandkids; he said yes. I asked him if that meant I could run; he said if I wanted to.

See @sailnsun's comments experience reflected in this post in this forum:
https://connect.mayoclinic.org/discussion/3rd-knee-replacement-in-a-year-and-a-half-on-same-knee/
Good luck.

Steve

Interesting. Four years ago when Dr. Chow replaced my left hip it was cementless. That was why he had a five week couch potato requirement ("The only thing I can't do is make bones grow.").

Six months ago he replaced my right knee. According to the post surgery report, he used a third generation cement technique. I don't know whether he would do a cementless knee replacement but you could certainly ask him. I have not focused on the cementless vs cemented issue. I do suspect that if it is press fit, there will be a longer passive waiting period.

Dr, Chow is one of the very, very few who do and have done many BCRs. A BCR cannot be done if the ligaments are not strong. Dr. Chow was pretty sure from the MRI that my ligaments were strong enough but he did confirm that once he opened me up he found an intact and functional ACL.

At my six month checkup I asked him if I could run. He said if I wanted to.

If you do go cementless, I would suggest being very careful early on not to run before the surgeon confirms that your bones have properly formed around the implant.

@steveinarizona
Thanks for the response. I have done some additional reading just this moring on cemented vs cementless tkr. One study I read discussed the challenge of fitment on the femur due to the need for 5 perfect cuts to get a perfect fit of the prosthetic. This apparently makes it more challenging to get the contact required for organic bone bonding to the new joint. Makes me think maybe cemented is lower risk for the femur. I'll be interested to hear what Dr. Chow has to say.

I kind of think my ligaments are likely in good shape, but time will tell. It Dr. Chow's experience with BCR that draws me to him.