Advanced Knee Care

Knee Surgeon and Specialist Stefan D. Tarlow, M.D.

The Basics of Choosing a Knee Surgeon

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choosing a knee surgeon

Knee problem can be complicated that it sometimes leads to replacement surgery. People choose to undergo surgery because they have suffered enough from the discomfort, the pain and the other symptoms associated with their knee problem. But the procedure itself is not the only thing that people should consider. Equally important is the surgeon who will conduct the operation. That is why choosing the right and best knee surgeon is highly important to the success of the surgery and for the recovery as well. With this, we listed some of the basic things to consider when selecting a knee surgeon.

Basic Factors to Consider When Choosing a Knee Surgeon

  • Experience

This is highly important to the success of the surgery. Experience sharpens the skills and knowledge of a professional. So when you choose a knee surgeon, make sure to check how long has he/she been practicing and what disciplines is he/she most experienced at. You must also ask how many times has the surgeon performed knee replacement surgery and does he/she perform such many times a year? Questions like this help you establish the competency of the surgeon.

  • Education

The training, education and degrees of the surgeon also speak of his/her competence in the field. That is why you must consider and review the surgeon\s education, training, degrees, fellowship and board certifications.

  • Check Online

You can verify the surgeon’s credentials and education online. In the U.S., you can look into the surgeon’s disciplinary record and reputation through any of these associations’ respective website: American Medical Association and Academy of Orthopedic Surgeons.

  • Ask Questions

It is your right as a patient to ask questions. After all, it’s your condition and health that are in line here. Try not to feel intimidated and uncomfortable when asking questions. Raise your concerns about the procedure, its success, the possible complications, the recovery time, etc. You can even ask the surgeon directly about his/her experience and credentials.

  • Second Opinion

If you are not comfortable or satisfied with the first surgeon you approached, you can always try a second opinion. The surgeon usually understands if you are not at ease and are requesting for a second opinion.

  • Trusting Your Instincts

Sometimes, you just have to trust your gut. Weighing in all the considerations mentioned above, you can just go with the surgeon you have a good feeling about.

Knees-Only Surgeon

Orthopedic surgeons perform knee surgery. However, in general, they are not specialized in knee replacement. If you really want a surgeon who is highly trained and experienced in knee procedures, go straight to a knees-only surgeon. In Arizona, TarlowKnee is the place to go. Dr. Tarlow is a knees-only surgeon who perform advanced procedures like knee replacement. Learn more about Dr. Tarlow today.

Cartilage Restoration

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Cartilage restoration

Cartilage restoration has provided a great treatment option for people, mostly athletes, who have injured or damaged their cartilage, which does not heal on its own. Modern technology and innovations in surgery have made it possible, bridging the gap between traditional joint replacement surgery and symptom relief.

Full thickness chondral defects in the knee joint (known as cartilage damage)is a painful condition that is caused from a violent twist or shear injury. This creates a painful crater in the surface of the knee joint that leads to pain, swelling and limited activities. This condition is diagnosed by MRI scan or knee arthroscopy (surgical procedure to look inside the knee) since X-rays do not show this injury. These lesions rarely heal and require a surgical procedure termed “cartilage restoration” to resurface the damaged area of the knee joint surface.

There are different surgical strategies to treat this injury depending on lesion location and size and age. Thanks to modern approaches, there are now many ways to repair damaged cartilage. However, some of the available cartilage restoration options have not yet been approved in the US, particularly the unorthodox ones. So if you want trusted and proven treatment, the following are the most commonly referred to by specialists and professionals: Microfracture, Autologous Chondrocyte Implantation, and Osteochondral Autgraft.

Cartilage damage usually affects the athletes. Since athletes need to return to sport as soon as possible, they need a reliable surgery with fast and successful recovery. Studies show that many athletes can return to sport after a successful cartilage restoration surgery. In fact, the return rates of each type of cartilage restoration surgery are as follows: Microfracture -75%, Autologous Chondrocyte Implantation (carticel or maci) – 84%, and Osteochondral Autgraft (OATS) – 89%.

  • Microfacture

This surgery is an older technique that is still used to repair damaged cartilage. It’s the most inexpensive cartilage restoration treatment. However, it’s not the best treatment there is. It slowly loses its durability five years after the surgery.

  • Autologous Chondrocyte Implantation

This is more modern and innovative than microfacture. In fact, experts believe that it has significantly outperformed microfacture. In this cartilage restoration, a combination of tissue engineering techniques and cell therapy are employed. The cartilage cells are grown and produced first before the bio-engineered implants are placed. Since it’s a more modern approach and has higher return rate, it is more expensive than older and traditional techniques.Cartilage Restoration

  • Osteochondral Autgraft (OATS)

Of the three main cartilage restoration surgeries, this is the one with the highest return rate. It successfully restores, not just repairs, the hyaline cartilage. It involves transferring a small cartilage or bone from a healthy part of the patient’s knee and placed such in the damaged cartilage to let it naturally grow and produce. It’s more expensive, but it is more efficient and effective than the first two treatments.

The surest way, as always, of finding out which cartilage restoration surgery is best for you is to consult a specialist. You can check out TarlowKnee if you want your knee treated. We are knees-only orthopaedic surgeons. We provide advanced knee care and treatment such as cartilage restoration surgeries.

Make an appointment with us today.

Should I Wear a Custom Knee Brace after ACL Knee Surgery?

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acl knee surgery

ACL is one of the major and most important ligaments found in the knee. It is also susceptible to tear and injury. This kind of injury is common among athletes, particularly those playing sports which involve sudden changes in direction, stops, and jumping. ACL tear is a serious injury in the knee. If you have this, it becomes too painful and unstable for you to bear your own weight.

ACL tear can be treated in various ways, depending on the severity of the injury. However, in worst cases, reconstructive surgery is necessary. Patients undergo ACL knee surgery to fix their injury. This is followed by months of rehabilitation. After the rehabilitation, the athletes and other individuals who have undergone such reconstructive surgery will find themselves returning to their normal lives.

Many patients, particularly athletes, use knee brace to protect their knee from reinjury and to help them be quicker and stronger in doing functional activities like jumping, pivoting and running. So the question now is: should one wear a custom knee brace after ACL knee surgery?

There is no scientific data that supports this. It is true that wearing functional ACL brace helps protect the knee from twisting forces. It may also protect the implanted ACL graft particularly during the rehabilitation period. Some athletes feel more confident and safe when they are wearing a brace. They feel that it helps joint position and lowers their fear of reinjury. They believe that the ACL brace will prevent reinjury during the transition back to their normal lives and activities.

However, there is no scientific evidence that supports this belief. Based on scientific data, it is not yet proven that ACL brace help decrease the rate of reinjury. Not to mention the fact that the effectiveness of the brace diminishes as the activity levels increase.

Nevertheless, braces do increase the patient’s confidence in themselves, which psychologically helps them live and functionally normally again. Braces also protect healing tissues during the rehabilitation period.

Going back to the question, should one wear a custom knee brace? Yes, though it does not totally guarantee that you will be free from reinjury. Knee brace definitely helps in promoting a smoother and more efficient transition back to work or sport. In fact, in selected patients, ACL braces are prescribed as part of the rehabilitation program. They are advised to use ACL brace 3 to 12 months after the reconstructive surgery.

If you still have doubts whether to use custom knee brace after the ACL knee surgery, you can simply ask your orthopaedic surgeon. Make an appointment with our “knees only” orthopaedic surgeon so we can cater to your needs and concerns.

Total Knee Replacement Revision

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Total Knee Replacement

Despite the success of Total Knee Replacement, it can still fail over time due to various reasons. The most common are the following: wearing out of the replacement artificial joint, dislocation, and fracture. When any of these occur, your knee may become swollen, stiff, unstable and painful. If this happens to you, you may need to undergo a Total Knee Replacement Revision.

Revision of Total Knee Replacement

Basically, Total Knee Replacement revision is a second surgery. This is recommended when the knee replacement fails for some reason. In this surgery, the doctor will remove, either totally or partially, the prosthesis or artificial joint and replace them with new ones.

In the first total knee replacement, the knee joint is replaced with an artificial one, an implant also known as prosthesis. Such is made of plastic and metal components. If these fail, they will be replaced with new ones during the revision procedure. This is so because the implant may loosen or wear out over time and due to other factors.

Different types of revision surgery are available. In some cases, the whole implant is removed and replaced; while in others, only its parts are replaced. The artificial joint or prosthesis has three main components: femoral, patellar and tibial. They come with metal pieces which serve as substitute for the missing bone. All these may be replaced with new ones or only some, depending on the patient’s individual situation and condition.

Generally, the primary and revision Total Knee Replacement have the same goal; that is, to restore and improve function and to relieve pain. However, revision surgery is a more complex procedure. It requires specialized implants, extensive planning and longer procedure. But the result is still the same or even better.

Commonly Identified Benefits of Total Knee Revision

The revision procedure generally has the same benefits as the primary Total Knee Revision. But studies show that majority of patients who have undergone revision surgery experienced long-term outcomes. Some of these benefits are the following:

  • Increased function and stability.
  • More efficient pain relief.
  • Faster recovery period.
  • Regain of previous mobility.
  • Getting back to performing normal activities.

TKR Surgery Fact: Do Both Knees End Up Being Replaced?

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total knee replacement

Not all who have knee problems need to undergo knee replacement. Most of the time, only patients with severe destruction of the knee joint or osteoarthritis end up having their knee replaced. The procedure is medically known as Total Knee Replacement surgery. In this procedure, the defective knee will be replaced with an artificial one. The diseased or injured joint will be replaced with plastic and metal parts which function normally and last long enough for the patient to enjoy doing normal activities again.

Total Knee Replacement is a popular procedure not only for osteoarthritis patients, but also to those who have devastatingly injured their knee. Despite the success and innovativeness of this procedure, some people are still wary of its effects. Some patients are still concerned about the pros and cons of Total Knee Replacement.

But it is not only this that they are worried about. There are reports that say once you have undergone TKR on your one knee, you will likely undergo another procedure on your other knee. Patients raise concern that once you have had one knee replaced, there is a high chance that your other knee will need replacement too. So the question that needs to be answered is this: do both knees end up being replaced? Is this a fact or just a myth? Let us find out if there is any truth to this.

To answer the question, let us take a look into a particular study conducted on the subject. A population study spanning 40 years was conducted. This question was addressed to the TKR candidates: if you had one knee replaced, what are the chances that the other knee will also be replaced through Total Knee Replacement surgery? Based on the data studied, the general finding is this: there is 45% chance that the other knee will be replaced within 11 years after the first knee replacement. In the study, the data of 2,000 total knee patients, spanning from 1969 to 2008, were analyzed. The results show that out of the 2,000 patients who underwent one knee replacement, 809 had their other knee replaced within 11 years after the initial knee replacement procedure. In fact, most of the patients underwent the second knee replacement surgery within 10 years.

Now going back to the question, the answer is yes, it is a TKR surgery fact that both knees could end up being replaced. But this does not mean that TKR as a procedure is not working. It just goes to show that once one knee has encountered an injury or another problem that needs surgery; there is higher chance that the other knee will also encounter the same fate. Still, this does not take away the fact that TKR is an innovative and important procedure. And if you indeed end up having your other knee replaced too with an artificial one, you can still count on the procedure just as you had during the first surgery. As long as it is done right and by the right professional, there is really nothing to worry about.

If you wish to know more facts about Total Knee Surgery or if you need to consult anything about your knee problems or injury, contact Dr. Tarlow at Advanced Knee Care. Make an appointment with us and we will help you with your knee issues.

Sex Life after Knee Replacement

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tarlow knee sexual functionKnee problems such as osteoarthritis affect millions of Americans every year. Aside from this fact, many people are not that aware that there is a correlation between knee problem and sexual function. Based on a research presented at the annual meeting of American Academy of Orthopaedic Surgeons (AAOS), osteoarthritis of the knee limits sexual activity.

In a survey of Knee Replacement patients, several patients were observed. These patients have undergone knee replacement surgery two years prior. The results and findings of such survey were published in the Journal of Arthroplasty. Before knee replacement, 45% of the patients with knee arthritis said that before knee replacement, their sexual frequency and/or quality was limited. They cited knee pain and limited knee flexions as the major factors that make having sexual activity challenging. After they have undergone knee surgery, 72% of the patients said that they were no longer limited by the aforementioned factors. Postoperatively, patients were able to resume sexual activity at an average of 2 ½ months (ranging from 0-18 months) after the knee replacement operation.

In another study, patients under the age of 70 with a mean age of 57.7 years agreed to participate. The study required them to answer and fill out questionnaires prior their scheduled for primary total knee replacement. They were also asked again six months and then one year after surgery. Out of the 147 patients, 78 of which are women and 68 are men, 65% participated in and completed the three surveys. The result of said study contains the following findings and generalizations:

  • 67% of the patients reported physical problems and limitations regarding sexual activity prior to the surgery. The common problems include stiffness, pain, reduced libido and inability to attain proper sexual position.
  • 91% of the patients answered that they experienced psychological issues related to their knee problem or osteoarthritis. The issues include low sexual self image and diminished sense of general well-being.
  • 90% of the TKR patients reported that they experienced improved overall sexual function after the surgery. More women reported improvement more than men. 42% reported improvement in libido; 41% said that their intercourse frequency has increased; 41% also said that they have increased intercourse duration; 84% of the patients reported that their general well-being improvement; and 55% attested that their sexual self image developed. Only 16% of the patients said that the surgery did not significantly affected their sexual function, particularly due to fear that the replacement joint might get damaged.

Sexual function is also a vital part of one’s life. It is only justifiable to include sexuality and sexual activity in the evaluation of the outcome of total knee replacement and other knee surgery. Sexual experience is part of one’s overall health and lifestyle, which is why it is great to note that knee surgery has something to offer as regards one’s overall sexual function.

But there must be a balance between sexual function and taking care of the knee replacement. This is better discussed personally with your surgeon or knee professional. If you need to learn more about knee surgery or if you want to undergo the same, contact Tarlow Knee. Make an appointment with us today.

Total Knee Replacement Fact: Obesity Puts Patients at Risk

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obesity and total knee replacement

Much is said about Total Knee Replacement. While many agree that it is a perfectly safe procedure, there are those who say that the surgery can be risky. One of the most common factors that increase the risk for knee replacement is obesity. There is a circulating belief that people who are obese are not fit to undergo TKR. There is higher risk for complications for patients who are obese, they say. How true is this and if so, what are the possible serious complications? Let us find out.

Let us take a closer look into this study conducted by Mayo Clinic which was published in 2016. The study seeks to the address the following question: Is Total Knee Replacement a more risky procedure in patients with high body mass index (BMI)? Luckily, this was answered in the same study.

The study used and reviewed the data of 22,000 patients who underwent Total Knee Replacement. The average BMI of the patients is 31. Out of the 22,000 patients included in the study, 5,500 have a BMI above 35. Based on the results of the study, there was an increased rate of repeat knee surgery (including revision total knee replacement surgery) as well a striking increase of knee joint infection, a serious complications in the morbidly obese group (BMI 35-40).

Complications arose following the Total Knee Replacement among the patients belonging to this group. This answers the question as to the complications that obese patients might encounter after undergoing TKR.

However, in the same study, it has been noted that the risk for complication can be minimized by delaying surgery until obesity and other modifiable risk factors are reversed. While obese patients are at risk for complications when undergoing the procedure, the case is not totally hopeless. In fact, the case can be remedied and these patients can still continue with their treatment with less risk. The risks can be minimized through best practices. This calls for experienced and reliable professionals. If the surgeons employ best practices and proven strategies, they can maximize patient outcomes and surgical success, as well as minimize risk for serious complications among obese patients. In other words, the key to lowering or totally eliminating the risk for such patients during and following TKR is to have the procedure conducted only by trusted and proven professionals.

So if you are obese and you have knee problems, don’t consider yourself as a hopeless cause. You can still have your knee issue fixed without having to worry about serious complications following the knee replacement. As already said, it’s just a matter of employing best practices With the right preparation and right measures before, during a and after the procedure, you will have a successful TKR operation. To reiterate, the key to a successful surgery is a reliable, trustworthy and experienced surgeon.

If you are obese and are having doubts whether to continue with the procedure or not, give us a call. You do not have to look further to find the right surgeon who can ensure a successful, risk-free procedure. We know exactly what needs to be done and what’s appropriate for you and your condition. Our surgeon has the right experience, expertise, knowledge, practices and passion for this kind of procedure to work. Make an appointment with us today for a consultation.

Experience Matters: Find the Right Surgeon for Knee Replacement

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Find Knee Replacement surgeon

Being experienced is always an edge. Experience is highly important to the success of any endeavour, especially technical ones like medical procedures and surgeries. Knee surgery like unicompartmental knee replacement is specific and technical, and requires not just skills and expertise, but most importantly practice and experience. This is why it matters that you choose a surgeon with specific experience in performing the above mentioned procedure.

Before we tackle the importance of experience to the success of a knee replacement, let us understand the basics of unicompartmental knee replacement or arthoplasty first. This surgical procedure is also known as partial knee replacement, as opposed to total knee replacement (TKR). This procedure is most commonly used to treat and relieve arthritis affecting the knee. If the knee is not totally damaged but only parts thereof such as the medial, lateral or kneecap; only the damaged knee compartment or parts are replaced. This surgery has shorter recovery period and reduced post-operative pain. However, if the whole knee, that is, all the three compartments are damaged, the best solution is total knee replacement.

Whether it’s partial or total knee replacement, it does not take away the fact that the procedure is highly specialized. Not all surgeons perform these procedures. Only those with the special training and education can perform the same. This explains why there are knees-only surgeons.

Now you have a picture of what it takes to perform unicompartmental knee replacement successfully. Training, background and skills are important. But constant practice and experience are even more important. This is how you test whether the surgeon is better or not, this is what separates a best surgeon from the better or the good. With this, it is helpful if you look into the track record of the surgeon and see how many times has he done this type of surgery and what is his success rate. To be sure, you can go directly to a knees-only surgeon.

Knees-only surgeons are focused on treating knee injuries and other related problems. Their training is highly specialized. But again, not all knees-only surgeons are the same although they may have the same level of training and background. What sets a great doctor apart is his experience. We again emphasize the importance of experience when you choose a surgeon to perform a unicompartmental knee replacement or any knee surgery for that matter. The surest way to a successful procedure and fast recovery is through an experienced knees-only surgeon in Arizona.

If you are in need of one, you don’t need to go far. Contact TarlowKnee today and schedule your appointment.

ACL Reconstruction Recovery

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ACL reconstruction knee surgery includes repairing or reconstructing the ACL, which is the anterior cruciate ligament. This type of surgery benefits the athletes who have injured or torn their ACL.

Effective, efficient recovery and patient satisfaction are two of the most important goals after ACL reconstruction knee surgery. This is done by restoring the normal stability of the knee, as well as the level of function. It also helps prevent degeneration and possible injuries in the future.

ACL Reconstruction Recovery

How effective is ACL reconstruction, especially when it comes to the return to play aspect? Let us take a look into a study conducted in New York. The study involved 230 patients and the results of which were published in the Journal of Bone and Joint Surgery in 2017. Based on the study, the efficient recovery and patient satisfaction are high after ACL reconstruction recovery in active athletes. The results and findings of the study are reported and recorded as follows:

  • 87 % of people returned to play by a mean of 10 months (range 3-17 months)
    Most notably, patellar tendon autograft patients had the highest likelihood of return to play. However, it was found out that participation in soccer and lacrosse decreased the odds of returning to play; as such sports require strenuous and intense usage of the knees and legs.
  • 95 % of people were satisfied with their surgical outcome, most of which are athletes. Moreover, 98% of patients stated they would undergo the surgery again. This goes to show that the patients who have undergone ACL reconstruction felt stronger and more confident after the procedure.
  • However, there are patients who are concerned about the “strength” of their knee. In fact, this is the most common reason why patients are afraid to or have doubts of returning to play.
  • But overall, patients who returned to play were very satisfied with their surgical results.

The important thing about ACL reconstruction is its effects and satisfaction rate. You may not be able to restore the same function as the original, but at least you will still be able to return to play and engage in sports and other activities.

If you wish to know more about ACL reconstruction, how it works, what are the risks and others, check out Tarlow Knee. We perform ACL reconstruction and other knee surgery. Make an appointment with us today.

Total Knee Replacement Myth Busters 2017

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Total knee myths photo

There are various reasons why patients opt for total knee replacement. The most common reason is that, to them, knee replacement shows a lot of promise in achieving a better lifestyle and better movement. They undergo this surgery in hopes of gaining a more active life. However, many of these patients go into surgery believing in “myths” regarding what awaits them after. Some patients look at knee replacement as the ultimate solution, while others see it as something to be avoided, if at all possible. In the eyes of the patients, there is a fine line between what’s true and what’s not.

Here is a list of several myths about total knee replacement:

  1. Exercise alone, without knee replacement, minimizes pain and maximize function.

This is a myth. In patients with end stage knee arthritis, exercise and therapy alone do not minimize knee pain nor maximize function. Exercise, therapy and optimized personal fitness must be combined with Total Knee Replacement surgery to achieve the highest functional improvement and maximum pain relief.

  1. New technologies improve patient-perceived surgery outcomes.

The fact is in the contrary. The truth is, new technologies like minimally invasive surgery incisions do not improve patient-perceived surgery outcomes.

  1. Advanced implant designs improve patient results.

This is another myth. Advanced implant designs include mobile bearing knees, single radius knees or high flex knees. There is no evidence that these will improve patient results.

  1. Cemented fixation of the implant is not reliable.

Another myth. Cemented fixation provides reliable and durable fixation. You can also opt for cement-less knee design. However, there is no sufficient data comparing cemented and cement-less fixation. But you can count on the durability and reliability of cemented fixation.

  1. TKR is painful.

With the help of modern-day technology and pain management, Total Knee Replacement is not painful. There are now innovative and effective measures to ensure that the patient does not feel pain during or after the surgery.

  1. TKR affects an active life negatively.

It does not. In fact, it helps promote a better lifestyle. Certain activities such as driving and walking will be much easier and comfortable after the surgery. However, you must still observe proper care and avoid contact sports.

  1. Knee replacement patients take a long time to recover.

Again, this is a myth. Full recovery can be expected just within six weeks. In fact, the patient can already do toilet activities independently in just 24-48 hours after the surgery. In three weeks’ time, the patient can already participate normally in basic outdoor activities.

  1. Knee replacement does not last very long.

Some say that it only lasts 10 years or even less. But this is another myth about TKR. Knee replacement can last a long time, even longer than 20 years. With recent advancements in technology, knee replacements now last longer and work more effectively than they used to twenty years ago.

  1. The newest technologies are nearly perfect.

Technologic advances in surgical technique are available. The benefits of computer assisted surgery, including computer navigation, robotics and patient specific instruments, remain uncertain at this time. These technologies improve prosthesis position but positive impact on pain and function remains undemonstrated.

If you wish to know the truth about Total Knee Replacement, the surest way is to talk to a reliable and experienced professional. Make an appointment with the only best orthopedic knee surgeon in Arizona.

 

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