Total or Partial Knee Replacement?

About 60% of the questions on my Joint Replacement Message Board concern the differences, pros and cons of total knee replacement and partial knee replacement surgery.

Knee replacement has nowhere near the patient satisfaction of hip replacement or unicompartmental knee replacement. Period. There is NO controversy about this. Patient satisfaction ranges fron 65% to 90% depending on the study and how in depth the questioning is.

More than a few patients who have undergone total knee replacements are unsatisfied. There are many factors that contribute:

• Patient perception
• Patient expectaton
• Underlying disease
• Associated spine and hip problems
• Scar development

The real issues related to partial vs. total have more to do with surgeon training, skill, and philosophy.

Let me explain. I saw a patient who, in my opinion, (after over 350 partial knee replacements and 1200 total knee replacements) was a CLASSIC partial knee candidate. I discussed with him both options. He then went for a second opinion to a well-known joint replacement hospital in Manhattan. The surgeon got close to 12 separate x-rays and carefully described to him all the complex reasons why he needed a total knee replacement. The patient told me about this.

I asked the patient one question: "Did you ask how many partial knee replacements this doctor has performed in his life?" The patient said "no." I then told the patient the truth that this doctor, while respected in the joint replacement industry NEVER performed a partial knee replacement in his 25-30 years of practice. Therefore--when your only tool is a hammer--everything looks like a nail...Enough said.

Get an opinion from someone who regularly performs both operations. Do not settle for surgeons that are stuck in old technology, have residents do the surgery, or fail to give the patients balanced opinions.

Currently 50% of my knee replacements are unicompartmental (partial knee) and the patient satisfaction levels are superior. We will see a shift in the coming years to alternative procedures to a total knee replacement due to the high level of patient dissatisfaction with total knee replacements.

Related Topics: Joint Replacement: Less is Sometimes More, Joint Replacement (Sponsored), Targeting Arthritis

Technorati Tags: arthritis,knee replacement,unicompartmental

Sports Injuries

Thank God we have Orthopaedic Surgeons because children's sports leagues are battering our kids.

I saw a nurse in the recovery room today who relayed a story to me about one of my patients -- her adorable 9 year old daughter. The child had an elbow fracture 3 weeks earlier. I should have known trouble was brewing when the mother asked for 14 notes, 3 immigration Visas, a pardon from Gerald Ford, as well as Holy Communion from the Pope to be able to return to soccer. I had no problem with the documentation, of course. A note from the doctor is like Rolling Stones tickets with your first date- you clutch onto the paper because it will get you what you want.

What's the problem here?

It seems that when she returned on the first night, the child's arm was getting cold and the mother pulled her from the game. The mother was called the next day and was to appear before the "President" of the league. What was at question was that the mother did not have the authority to pull the kid from the game and my note was confusing. The surprise to me was not the questioning of my note but the questioning of the mother's judgment. Where I come from, the pecking order of medical knowledge is the following:

1. Mothers
2. Nobel Prize Winners
3. Everyone Else
4. Tree Shrews
5. Doctors

To this day, while I know that it is bacteria that cause pneumonia I always worry when I go outside in the winter without a coat because, according to my mother, that will cause pneumonia. Stay out ten minutes longer- "double pneumonia."

So why is the President of the Soccer League daring to question Dr. Mom?

My theory: It seems that children were not getting enough injuries on their own. Stoop ball, stick ball, and pick-up basketball games weren't doing the trick. Therefore, organized youth sports were born to systematically maim the youth of America.

In soccer, if anyone happens to kick the ball they invariably fall, twist an ankle, break a wrist, or dislocate a finger. I love this game. My office loves this game. The question I have is: WHAT ARE WE DOING TO OUR KIDS??? They are over-programmed in 19 leagues, 12 clinics, and 30 travel teams and everyone comes to the office and wonders why little Johnny's knee hurts. Is that a trick question?

Here is a mother who makes a decision to protect her child (quite appropriately I might add) and she gets flack for it. Give it a rest everyone- it REALLY is only a game. Lighten up on the competition at a young age and bring back a little fun to activities. Interested parents should be just that and not league Presidents and Commissioners. Maybe 15 million bones won't be broken if we cool it down a little.

Related Topics: Sports Injuries Raise Cost of Active Life,Knee Injuries: Prevention, Football Injuries

Technorati Tags: sports injuries,knee injury,broken bones

Welcome!

People often ask me why I went into medicine. For me, the answer is easy. The role of Jerry McGuire opposite Renee Zellwegger was taken by Tom Cruise so I had no other choice. I figured that being a doctor was my only chance of meeting Ms. Z since she would eventually sprain an ankle or break a bone. I thought it was a good plan at the time. Who knew?

The real "why" is this: I love medicine and surgery -- orthopaedic surgery in particular. Here are some random facts about me and my current practice:

• The year prior to bringing an associate into my practice, I personally saw over 5,500 office visits and performed nearly 300 major Orthopaedic surgeries.
• My office became totally paperless and digital in 2000 and I lecture around the world about this. Along the way I was involved in the development of medical multimedia and Medscape- starting a web site that was bought by Medscape and became Medscape Orthopaedics with me as the Executive Medical Director.
• I am a minimally invasive surgery evangelist -- I do more joint replacements than anyone in my hospital, and my hospital does the most in the county.
• I open my office for any kid with any injury 24 hours a day, 7 days a week.
• I don't mind seeing patients with back pain.
  
• I do house calls sometimes.
• My patients get my cell phone number.
• No one is wishy-washy about what I do: they hate or love it. It's black and white- no one in the gray.

If you have a doctor that cares for you- you are gold- and that is why American Medicine is the jewel of the last century. Dedicated doctors, nurses, and others are contributing to making us healthy every day.

The picture above? That is me playing Stevie Ray Vaughn's guitar, sitting on Jimi Hendrix' couch, next to Freddie Mercury's chair at the London Hard Rock Cafe vault. Now that's livin'...

Technorati Tags: medicine,surgery,orthopedic,orthopaedic