Nanoknee, is it better or merely hype?

@gratefulbob
Did you consider Nano surgery over TKR?
Thanks,
Jay

@judycat wow. this is an impressive report. I need them both done but the Right Knee is pretty bad now. I had previous ACL repairs in both and the routine cartilage excision. I wonder if that makes a difference? I should get the Right Knee done since I can only walk about 2 blocks before the "pinching" starts....

@steveinarizona What is BCR?

@latteman

I have an incredible surgeon. I was chatting with him one day and mentioned that I had a friend who was scheduled for a "Jiffy Knee" and asked him what he thought. He said it all depended upon the skill and experience of the surgeon. I told him who and he responded that he had seen no problem from that surgeon's work (a compliment as my surgeon spends 20% of his surgical time revising the work of other surgeons).

I would say the same thing about a Nano knee. Is it worth the extra cost; that depends. I don't know where you are located but one of the problems with Nano Knee or Jiffy knee is that they hide what they are doing. Other than a minimally invasive approach, it is not clear what they do.

It will take work but you likely can find an alternative who will do the same thing they are promising, and perhaps even better. The web site says most of the patients are moving within two hours and home within 24. Wowee. That is true these days of most knee surgeries.

What should you be looking for as an alternative:
1) a subvastus or midvastus method. There are many, many surgeons these days doing subvastus methods which is what Nano Knee uses. My surgeon uses a compromise alternative, the mini midvastus, which is slightly more invasive (it means going through the muscle fibers rather than under them) but provides the surgeon with a better field to work in.

Many knee surgeons, especially traditional ones, use a tourniquet. Recent research suggests it is not necessary and might be counter productive. Many patients who have had a tourniquet complain about post surgery pain derived therefrom. I suspect that part of the Nano Knee process is to not use a tourniquet.

I also believe that part of the Nano Knee process is to do a kinematic alignment. This is an improvement on the traditional mechanical alignment. But, again, many surgeons now do kinematic alignments and the slightly newer inverse kinematic and Functional alignments.

My incredible surgeon used a mini midvastus method, did NOT use a tourniquet, put in a bicruciate retaining implant (extremely rare and it requires more complex surgery), did a Functional alignment and a plastic surgery close. I was up right after the surgery speaking with my surgeon, then home. My surgeon's recovery protocol was to be a couch potato for the first week, then begin some activities in the second week and commence physical therapy in the third week. I had zero post surgical pain. I followed his protocol and in the third week my physical therapist measured my range of motion (ROM) at 122. The recovery target for many is 120. I am an 80 YO male and on the 27th day after surgery, I was playing golf.

My surgeon has withdrawn from Medicare and doesn't take insurance. But his fee is less than the Nano fee and the rest of the costs were covered by insurance. My surgeon also replaced my hip (other side) about three years ago and I had zero pain that time also.

I would rather have my surgeon any day than a Nano surgeon. Both use a robot assistant. Mine used the CORI robot. While Nano does a kinematic alignment, my surgeon did the newer Functional alignment to correct my severe misalignment. Kinematic alignment involves cutting the bones in a femur first approach and inverse kinematic involves cutting the tibia first. Functional adds soft tissue work as well.

You will probably have a decent outcome with a Nano surgeon as they do use the "Southern" approach, probably do not use a tourniquet, and do a kinematic alignment. You can probably do better with a lot of research. Here are my criteria:

1) subvastus or midvastus method;
2) does not routinely use a tourniquet;
3) [this one is likely unique to me] able and willing to do a bicruciate retaining implant (BCR);
4) Does a functional or at least a kinematic/inverse kimematic alignment;
5) HAS EXTENSIVE SUCCESSFUL EXPERIENCE DOING THE EXACT PROCEDURE;
6) Has great hands;
7) Has a great mind.

99+% of knee replacements involve cutting and removing the ACL and having the implant perform the duties of the ACL. Many are done "cruciate retaining" where the ACL is cut but the PCL is retained and the rest are done "posterior stabilized: where both the PCL and ACL are cut and removed. In a BCR both the PCL and ACL are retained and protected.

I would be very surprised if a Nano surgeon did a BCR but I would be similarly surprised at almost any other surgeon besides mine. So this is probably not a reasonable criteria for others.

But it does take a lot of research to find a surgeon who satisfies all my criteria (as mine does). Nano knee is a shortcut to a reasonable alternative.

@silvernblack

See my reply to @latteman below.

@silvernblack
Do you live in California or close by? Check out Dr. Ferro, Nano Knee. There are some patients that have both knees done at one time with Nano Knee because it is much less invasive & much less pain. I would never advise having both knees done with the traditional knee replacement. But with Nano Knee...replacement of both knees is doable.
If you have a PPO plan...get a consultation with him. He has several offices in the LA area for a consultation. Good Luck!

@judycat thx. Was wondering if nano knee was worth it. I reckon I'll speak with them in the beginning of the year. Already communicating with them but wanted outside input. And, yes, I have a real PPO (not MAP) and Medicare

To me it was worth it because I didn't suffer like I had previously 11 yrs. ago with my traditional left knee replacement. I have 2 friends who also had the Nano Knee & recommend it to me. My girlfriend had the traditional TNR , she claimed that her surgeon was the best & decided against the NanoKnee. Boy did she suffer! For the first 3 weeks, she was in severe pain & on Norco for over a month. She is finally getting better after 2 months. So, yes...either way, you will have probably have a good outcome...it just depends on your level of pain, opaites, & lots of painful PT. I decided to give up a trip & instead spend it on my body.
If you can afford it...do it...if not go for the traditional.

Never heard that term. Do you/they mean a UniKnee or a Custom made knee implant?

Retired now but took care of so many TKR patients.
We basically almost quit doing Unis because of poor long term outcomes.
Custom joints are, IMO, the way to go and I had mine in 2009 and never a problem!

@judycat

If the choice were a traditional knee replacement or a Nano Knee, IMO the choice is easy: go for the Nano Knee.

However, there are many choices out there besides those two. I was in PT yesterday and there was another rehabbing TKR patient there who described her recovery pain as really "just some discomfort". She told me the name of her surgeon and I looked him up when I got home. He uses a subvastus method and a Mako/Triathlon replacement. Essentially a Nano Knee without the trademark.

To repeat my advice: find the best surgeon you can who does a minimally invasive method (subvastus/midvastus) whether called Jiffy Knee, Nano Knee or Steve's Knee with lots of experience doing it.