Lateral Approach Total Knee Replacement

@steveinarizona

Five weeks ago I had my TKR. As in the case of my left hip replacement, zero meaningful post surgical pain. Once again I had a prescription for Oxycodone and never took a pill. On day 21 post surgery my physical therapist measured my ROM at 122. On day 27 post surgery I was on the golf course.

I did a ton of research to determine that I had the best doctor (I used to say in the state but now I say perhaps in the country). He did a mini midvastus method (comes in through the front but then slides down and goes under the tendon and through the muscle fibers), did NOT use a tourniquet, did a bicruciate retaining implant (Journey II XR -- kept my PCL and ACL intact) and did a Functional Alignment. Most importantly, he has done this exact procedure many times (I even found a video of him doing the exact same procedure in 2020 at an orthotics innovation conference). I went home the same day.

My heel pain is gone so it definitely was a nerve impingement caused by my pre-surgery misalignment.

My knee feels good although it is warm to the touch. My therapists are working on my quads and my ROM is up to 125. Now I have to work on my endurance as I spent the last nine months barely able to move.

@terrwynl My surgeon does not do a lateral approach either yet. It kind of seems that patient testimonies are all we can go by currently... but it concerns me to be one of the first in a surgeon's new way of doing things, no matter how great the testimonies. I was told those doing the "Jiffy" have done 10 procedures under Dr. Patel before starting their practices back home. Mind you, these are experienced ortho Drs already. The #s of surgeons trained with this approach is climbing.

I so appreciated the standards of care that I received from a Center of Excellence. I had received a binder-full of education for every step of the way. The road to recovery was aided by "Mychart" follow-up and great medication oversight (stomach, pain, anticoagulants...).

If I choose the new approach, will all those bases be covered? So much to consider. Shorter recovery time and better outcomes for flexion and extension will be my pursuit.

There are many approaches. Where you cut is just one of the decisions. some do lateral (like Jiffy knee), some do other subvastus methods, and some, like my surgeon, do mini midvastus. In all cases the goal is the same: minimize muscle, tendon and ligament damage while doing the replacement.

@cathymw
On day 21 post surgery my therapist measured my ROM at 122. Five weeks later it is hovering around 125/127. I don't know why I came out of the surgery with such good ROM and others much worse ROM. Was it the use of a bicruciate retaining implant? The Functional Alignment that Dr. Chow did to correct my severe misalignment and nerve impingement? The surgical skill of Dr. Chow? Pure luck? I wish I knew.

Congratulations on your successful TKR outcome. The factors that contribute to either successful or unsuccessful surgeries are too many to list. The 80/20 good to bad stats indicates TKR surgeries are a crap shoot. Best wishes on your good fortune.

@anemonejane

There is little new sometimes. Lateral approach just means doming in from the side as opposed to the top. Subvastus, including Jiffy Knee, does the same thing.

I distrust most professionals who advertise. Really good professionals don't need to advertise. The ones who do often make a lot of money playing off of the lack of knowledge of the readers.

The same thing has been happening in knee arthroplasties: Jiffy Knee; Nano Knee; lateral approach, etc. The lateral approach has been around for a long, long time. You can have a good Jiffy Knee or Nano Knee surgeon but I suspect that many of them are simply living off the name and advertising and are not anyone I would let inside my body.

It appears that the lateral approach is advisable for non severe valgus deformities:
https://www.sciencedirect.com/science/article/pii/S0972978X23002982
The article below shows the various approaches:
https://pmc.ncbi.nlm.nih.gov/articles/PMC12401512/.
My surgeon used the mini midvastus method. I think it is more important to find a surgeon with great hands and a great mind than to focus solely on the initial cut. There is a lot more to a TKR than that. What kind of implant is used? What material is it made of? Has it had any recalls? Is your surgeon using a posterior stabilized or cruciate retaining implant? Does your surgeon use a robot assistant? Does your surgeon routinely use a tourniquet (I sincerely hope not)? Does your surgeon still do a mechanical alignment (I hope not; Newer approaches are kinematic, inverse kinematic and Functional. I was severely misaligned and I had a Functional alignment.)? Etc.

I focus on the most important ones of these: method of cut, no tourniquet, non mechanical alignment, use of a robot. Most importantly, how often the surgeon has done the procedure that I want done on me.

My keys were that I wanted to retain my ligaments (a rare bicruciate retaining implant or BCR), have a minimally invasive method, and have a Functional alignment and I wanted a surgeon who was extensively experienced in all of that. I got all of that and came out of the surgery with a new knee, all of my ligaments, and no post surgical pain.

@steveinarizona
Hi Steve- Thank you for sharing about your experience. I live in Arizona and need to talk to a knee specialist. I won’t use the Dr who did my hip replacement. Who did you use? Thank you! Sue

@cathymw

I wanted a minimally invasive approach and got one (mini midvastus). But in my mind the most important criteria is extensive successful experience. I want my surgeon to have done the procedure the way I was going to have it at least a hundred times, preferably hundreds or even thousands of times.

I had this same discussion with my surgeon who is the primary inventor of the Superpath approach to hip replacement. Yet his three most important criteria are: extensive experience, great hands, great mind.

So...yes...look for a surgeon who does subvastus or mini midvastus procedures but only if she has done at least a hundred of them. Someone has to be the guinea pig...you don't want it to be you. This is very complex surgery and experience is everything.

@369hopeeternal

Used Dr. Jimmy Chow. I believe he is the best in Arizona and possibly in the US. There is one caveat however: he doesn't take medicare nor insurance. I had to pay his fee separately but the rest of the costs were covered by insurance.

If that is a no/no for you, then the Mayo Clinic has several excellent surgeons and there are several practitioners in Arizona who are also good. If you want to go Jiffy knee, Dr. Timothy Kavanaugh is good (a friend of mine was scheduled with him and I asked Dr. Chow about him and he was positive about him.

@steveinarizona
I’ve been saving all your great information. Now, to find a surgeon who can do this.
In the meantime, I’ve found icing, rest, elevation and increased NSAIDs helped immensely when I had a horrible flair up. I will postpone surgery as long as possible. I detest the entire industry.

Thank you for all of your great advice.