Thoughtful questions.
Straightforward answers.

I have predominantly utilized both the posterior and the direct anterior approach during my career. While many surgeons advertise the benefits of the anterior approach, I have found the posterior approach to be more reliable in my hands. There is a lower risk of wound healing complications, a lower risk of nerve injury, and a lower risk of femur fracture with the posterior approach. Furthermore, there is no difference in recovery between the anterior and the posterior approach. I find that using a smaller incision along the side of the hip provides excellent visualization to help me properly position the components, allows for excellent cosmetic healing, and gets patients back in their feet faster and more reliably!

I am a firm believer in Kinematic Alignment knee replacement surgery. Traditionally, knee replacements have relied on cutting the bone to reproduce “normal” knee alignment. The fact is that the vast majority of knee arthritis patients don’t fit the mold! In traditional (mechanical alignment) knee replacement, the ligaments must be released to allow the knee to balance properly, which can lead to increased swelling, early range of motion issues, and a knee replacement that feels less like a normal knee than it could. In kinematic alignment knee replacement, I personalize the knee replacement to match the patient’s unique boney anatomy without any soft tissue releases. This leads to less swelling, quicker range of motion and a faster recovery!

Knee replacement is a challing surgery to recover from. I tell patients that the first six weeks are extremely difficult and that full recovery can take up to a year. There are a lot of surgeons out there who advertise “special” techniques that result in a normal knee after only six weeks. There is no magic bullet that can avoid the recovery required to do well after knee replacement. Beware of any surgeon who offers a full recovery after only a few weeks! My goal is to guide you to a complete recovery rather than a quick one.

The Jiffy Knee has gained significant popularity in the last few years. The truth is that the Jiffy Knee is simply one surgeon’s spin on a decades old technique: the subvastus approach. This involves moving the patient’s entire quad muscle out of the way to implant the knee replacement. While this does avoid splitting the quad tendon, there is no high-quality data that this offers a drastically quicker recovery over standard knee replacement, and in more muscular patients it can dramatically reduce the exposure resulting in malpositioned components, poorer outcomes, and a higher likelihood of needing revision surgery. If you are interested in a muscle sparing knee replacement, just ask me! I am well versed in the subvastus approach and would be happy to use it if you are a good candidate!

Emerging technology is one of the hottest fields in joint replacement today. While the robot is the most popular and visible example of technology assisted surgery, there are multiple different ways to utilize technology in practice. Unfortunately, there has never been a single study that demonstrates improved long term patient outcomes when a robot is used in surgery. Also, there are some significant drawbacks to using the robot, including the radiation exposure from the preoperative CT Scan, the increased surgical time which could increase the risk of infection, and the potential for disaster if the robot fails during surgery. For all these reasons, I have elected not to incorporate robotic surgery into my practice.

Joint replacement is one of the safest and most effective surgeries in the world today, with a complication rate of less than 5%. The complication that I worry about the most is infection. I take every possible step to prevent infection, and my personal infection rate is less than 1%, but it is a big deal and potentially devastating complication if it happens; one that could require multiple further surgeries to correct. Other general complications include blood clots, injuries to nerves and blood vessels (very rare), and persistent pain. Hip replacements have the potential to dislocate (where the ball pops out of the socket), so we as patients to follow some simple precautions in the first six weeks to minimize that risk. Knee replacements generally don’t dislocate, but they can form scar tissue that could limit range of motion, which makes participation in physical therapy very important. The most common risk of any knee replacement surgery is dissatisfaction, meaning a year after surgery the knee still hurts more than we thought it would, or more than we think it should. This occurs about 10% of the time, which is why I make sure all knee patients have exhausted several forms of non-surgical care prior to proceeding with knee replacement.

Yes! The costliest part of joint replacement surgery is the care related to the facility (hospital/surgery center). This includes your implant, anesthesia, and other charges related to where you elect to have surgery. Our partners at the hospital/ASC will bill your insurance to help pay for these services, though you may still owe some money based on your deductible. If you have private insurance, we will help you submit paperwork to them to help you reimburse for some of my fee. Unfortunately, if you have a Medicare or Medicare advantage plan, we are unable to bill your insurance for any of our fees.