Advances in Knee Replacement: Partial Knee Replacements
I recently returned from observing at a course given by a device manufacturer concerning partial knee replacements. The course is given because the FDA mandates that for the company to sell the replacement to a surgeon the surgeon has to take this course. It is a 16-hour course. It does not qualify you to put in the replacement. It does not give you any skill you did not have before. It exists because of FDA rules concerning new products and their safety.
I bring this up because I saw this on a web site of an Orthopaedic Surgeon: "Dr. X is the only surgeon FDA-certified to put in the XXXXX partial knee replacement."
This, of course, is not true. It actually could be an offense punishable by the Office of Professional Medical Conduct because the FDA does not certify surgeons to put in replacements. They can only certify the sale or distribution of the implant.
What certifies a surgeon to put in a partial knee replacement? Last year I personally implanted over 125 partial knee replacements. According to the sales department of the device company whose implants I choose, this puts me at approximately number four in the nation for this particular implant. In fact, the number of partial knee replacements I personally implanted surpassed the combined number of the four largest medical centers in NY. Maybe, maybe not.
As previously noted here in this blog, surgical quality does have a connection to surgical volume. It is not direct and it is not absolute, but there is a connection. Of all the joint replacement procedures that have gained popularity in the last 25 years, a partial knee replacement demands a high level of surgical skill and experience. When I operate at a regional medical center and teach residents (surgeons in training) I commonly inform them that "the hands can only do what the mind knows." In other words, it is what you don't know that can hurt you.
Partial knee replacements have many advantages in the right patient. The recovery is faster and the results, from a patient satisfaction point of view, are consistently better than total knee replacements. It is crtical, though that the surgeon has the experience in doing the surgery. Do not be afraid to ask the following questions:
Don't be afraid to ask the obvious.
Dr. K.
Related Topics:
Technorati Tags: partial knee replacements, unicompartmental knee replacements, knee resurfacing
I bring this up because I saw this on a web site of an Orthopaedic Surgeon: "Dr. X is the only surgeon FDA-certified to put in the XXXXX partial knee replacement."
This, of course, is not true. It actually could be an offense punishable by the Office of Professional Medical Conduct because the FDA does not certify surgeons to put in replacements. They can only certify the sale or distribution of the implant.
What certifies a surgeon to put in a partial knee replacement? Last year I personally implanted over 125 partial knee replacements. According to the sales department of the device company whose implants I choose, this puts me at approximately number four in the nation for this particular implant. In fact, the number of partial knee replacements I personally implanted surpassed the combined number of the four largest medical centers in NY. Maybe, maybe not.
As previously noted here in this blog, surgical quality does have a connection to surgical volume. It is not direct and it is not absolute, but there is a connection. Of all the joint replacement procedures that have gained popularity in the last 25 years, a partial knee replacement demands a high level of surgical skill and experience. When I operate at a regional medical center and teach residents (surgeons in training) I commonly inform them that "the hands can only do what the mind knows." In other words, it is what you don't know that can hurt you.
Partial knee replacements have many advantages in the right patient. The recovery is faster and the results, from a patient satisfaction point of view, are consistently better than total knee replacements. It is crtical, though that the surgeon has the experience in doing the surgery. Do not be afraid to ask the following questions:
- When did you perform your first partial knee replacement?
- How many have you performed in the past month?
- Can you show me documentation that the number you said you performed is accurate?
- How many have you performed in the last year?
- Can you show me documentation that the number you said you performed is accurate?
- What is the most common knee procedure that you do?
- Can you show me documentation that the number you said you performed is accurate?
Don't be afraid to ask the obvious.
Dr. K.
Related Topics:
Technorati Tags: partial knee replacements, unicompartmental knee replacements, knee resurfacing
10 Comments:
Dr. K., I think these questions you bring up for us to ask, sound very good in the written word. In reality, I know of no doctor who would allow these questions, without them getting a very bad attitude towards us.
I have thought long and hard about these questions, and how they may apply to my own indiv. surgeons. They would not answer them, they would be offended, and they would not want to opearte on me, just because I dared to ask those questions. And especially because I asked for written documentation of what they have stated.
We all say "ask this" or ask that" but in reality, doctors do NOT want to be questioned. Sad but true.
Anonymous,
Then it is time to leave the Hospital for Special Surgery bandwagon and drive 45 minutes north to White Plains and see Dr. K. He does answer questions, will give information, advice, but most importantly, OPTIONS from which you make your own educated decision whether or not to go forth with surgery (or what type of surgery to go with). If he doesn't specialize in the specific surgery that you decide on, he will refer you to an expert surgeon that does. BTW, I understand that you may not be in the New York area or have used the Hospital for Special Surgery. I used this as an example which comes down to EGO. I'm sure if you asked a BIG NAME surgeon at HSS (who I'm sure is an excellent surgeon) those questions posed by Dr. K, you would get the response which you listed in your posting. Why? because of EGOs. They are the best! They know best! How dare a "layperson" question the "expert" (even though it is the "layperson's" livelihood/career/health/whatever on the line? If you went to HSS and could could actually benefit from a partial knee replacement, you would probably be steered toward a total knee replacement since they are easier to perform (I say "easier" for lack of a better term). As Dr. K once said, "when your only tool is a hammer, everything looks like a nail". A "top" surgeon who may be a realistic expert at total knee replacements will NOT refer a patient (who could benefit from a partial knee replacement) to another surgeon (if that original expert physician does not perform partials themselves). That would be saying "I can't do XXXXXX" so they perform the procedure which they are great at. The patient feels better. Success???? No, and the patient would not know because they never experienced the partial knee replacement (which, by the way, is upgradable to a total knee replacement in the future, if necessary). My point is that people often want to go to the big name doctor at the big name hospital. Look elsewhere, also.
The questions to ask a surgeon should be phrased in a professional but objective manner. None of these questions are accusatory in any way.
Here- read through:
When did you perform your first partial knee replacement?
In the Year 2000
How many have you performed in the past month?
Approximately 12
Can you show me documentation that the number you said you performed is accurate?
Currently that documentation is not available but I can have this confirmed with my surgical scheduler.
How many have you performed in the last year?
Almost 140
Can you show me documentation that the number you said you performed is accurate?
No there is no known database that has ths information.
What is the most common knee procedure that you do?
Unicompartmental knee replacement
Can you show me documentation that the number you said you performed is accurate?
As I said, that confirmation does not exist, you will have to take my word on these numbers but they are accurate.
That is how I would answer these questions. See- and I am not even mad at you :)
Dr. K.
Hi Doctor K,You give this advice.But i have to agree with the previous poster.About how doctors would be insulted.Even if people were to put it in manner of which you just said.Doctors look at you like.Do you think i am stupid.When asked these questions.You must be one of the good doctors.If you welcome these questions.I wish we had more doctors such as yourself.
Then you people don't have good doctors. I had a TKR in August of 2007 and I asked very hard questions of my surgeon. I didn't ask for documentation but I got the feeling that if I had he would have gotten it for me. He answered every question for me very humbly and very honestly and told me if I needed anything else or had any more questions all I had to do was call and ask. Not a problem. I go to a practice that has only OS in it probably over 50 of them each with their own specialities and if my surgeon is gone I can see another if I have a problem which I did with swelling and I saw no problem with ego or anything. I also need an ankle replacement which my surgeon does not do so he will refer me to someone else in his practice. I have every confidence in these surgeons just because of the experience I have had with the 3 I have been to. So, again, if you can't ask your surgeon these questions and get answers, you need to go to another surgeon. That is why there is such a thing as choice. I go 2 1/2 hours away for my surgeon when I could go 30 minutes. But that's my choice and I choose to exercise it. Hopefully you will too.
Actualy my last doctor was great and provided all information.Plus more.And yes the rest of the orthos were horrible.
Go to
http://blogs.webmd.com/mad-about-medicine/
even when you ask your dr. about the knee replacement and they answere them the best you know they make mistakes to last year in jan i had a total knee done an di'm not able to use it...thats right i can't use my leg i told the dr. i was haveing trouble and he told me. I DON'T KNOW WHAT ELES TO DO FOR YOU BESIDES PT.SO FOR A YEAR I DID AS I WAS TOLD AND YOU GUEST IT I STILL NOT ABLE TO USE IT all i'm trying to say is realy think about your knee replacement.befor you do it even the best DRS. make mistate also
It suprises me that so many people think their surgeons would not answer Dr. K's questions.
When I needed surgery to repair damage from tennis elbow, my doctor explained the surgery to me and told me that his success rate was 100%. He then went on to explain, without any questions from me, that the normal success rate is 87-92% and that this is not a very commonly performed surgery. He said he had done it about 15 times in his 25 years as a surgeon. He then gave me the option of going to a surgeon that specialized in hands and elbows.
I had seen the specialist before with a referral, but I knew my insurance would not cover the surgery from him. The specialist also explained the surgery to me the exact same way.
I decided to have the surgery. It has been a year and I can't believe the difference in my arm. He may not have had the most experience, but he was willing to tell me that before I decided on the surgery.
I think any good surgeon would answer those questions without hesitation.
Dr. K.,
I'm a 46yr.old Afro-American female and had a Total (L) knee replacemaen 12-10-07 @ Milton Hershey Hospital in Hershey,Pa. by a well-known surgeon, and the surgery didn't go well at all:( My (L)knee won't straighten out, I went back 3weeks after the surgery and Dr. D. manually broke up scar tissue in the knee and I've been to Physical Therapy twice for a total of six months and then the last resort was Botox shots and they didn't help. Dr. D. told me that there wasn't nothing else that he could do for me and said that he'd see me in a year! So, I'm taking Lorcet 650/10 (2) every six hours for the pain and the (R) knee needs too be replaced it's given out on me several time's. I've lived with this pain for 29yrs. of the 46. I just feel that Dr. D. did something wrong :((((( I can't do any of the thing's that I could before this operation: walking my dog 16 blocks (3)times a week,riding my bike, getting a "good" night's sleep and I had to quit my job of 8 yrs. because I can't stand for the 10hrs. a night. I've gone from Short-term disability to Long-term Disability.
I feel anger most of the time and have talked about it w/My Jesus but the pain's still there. Can you give me something "more" to hang onto? Thanks, Theresa Terry
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