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The first thing that we will determine at your office visit is whether you’re a candidate for a TKR. That determination is based on several criteria. First and foremost the x-ray of your knee needs to demonstrate evidence of cartilage loss and arthritis. In most cases this is pretty easy to see and I will go over your x-ray with you. A simple set of x-rays taken preferably at the SMIL facility located conveniently next door is the best way to determine the extent of arthritis. These are digital x-rays which will be displayed on the computer in your examining room. Occasionally, I will order an MRI or Bone Scan if more information is needed.
I will then watch you walk and examine your knee. Often range of motion is compromised with advanced arthritis. If the arthritis is severe your leg may have become bowed or “knock-kneed”.
We will then discuss your pain and limitations. We will assess how your knee compromises your activity level and quality of life.
If I determine that you are a candidate for total knee replacement I will discuss my surgical plan with you and what you can expect from the morning of surgery through the healing phase, to complete recovery. I have two very experienced R.N.s who will also go over what you can expect and answer specific questions you have pertaining to aftercare.
See you in the office,
Ted Firestone, MD
There’s a lot of information out there for patients considering knee replacement. It can be confusing! Implant companies have begun buying advertisement time for direct to consumer marketing. Computers, robots, minimally invasive, etc. are terms talked about which only confuse the issue. When we meet I will discuss what I believe is the state of the art in total knee replacement and what I think would be best for your particular case. I most frequently use the Smith & Nephew Knee System. If offers the most sizing options, including a narrow/female version. It also demonstrates excellent wear characteristics for long-term durability. I am familiar with several knee systems and have achieved successful results with the Zimmer system as well as the Johnson & Johnson Rotating knee implant. I treat patients as individuals and don’t do every knee replacement the same way. I believe that a 45 year-old ex-NFL player’s knee replacement is a different procedure than the knee replacement in an 80 year-old petite woman. I will also customize your post-op course accordingly. I prescribe a therapy regimen that’s most suitable to the individual’s bone quality, body type and lifestyle. It is this personal approach which I believe has helped establish the reputation of the Joint Replacement Center of Scottsdale. I look forward to showing you the implant in person so we can get a better idea of what I’m talking about.
Ted Firestone, MD
You can rest assured that your entire surgical procedure will be performed by me, skin to skin. It’s interesting, many people have asked me why I don’t have a fellowship program. The reason is simple, I treat people the way I want to be treated, and if I was going to a surgeon because I felt he was the best, I would expect him to do the entire surgery. That’s why doing both total knee replacements in my father wasn’t that big of a deal to me…I try and treat all patients as if they were family members. Obviously, fellowship programs are essential, but that’s not what my practice is all about. I do require an assistant and often have a young orthopedic surgeon who works with me, but he learns by watching and assisting.
I use a select group of anesthesiologists who are familiar with my practice. They contact all patients the night before surgery. They are all quite proficient with spinal anesthesia and preventing post-operative nausea.
When you awake, you will have absolutely no pain and later that day will be able to walk with physical therapy. Let me know if you have any other questions.
Ted Firestone, MD
The late Sir John Insall, the father of modern total knee replacement, said that TKR is a soft tissue operation. I agree with that. A monkey can make the bone cuts, but the management of the ligaments, so-called ligament balance, is the key to success, both short-term and long-term. The ligaments are either lengthened by sub-periosteal release or tightened by increasing the polyethylene thickness. The goal is to create symmetrical tension as the knee goes from extension to flexion. The patellar has to be centered at the same time and I would expect your knee to be able to flex at least 125 degrees. Stability is the key and I will make your knee very stable.
I have one of the largest series of Revision Total Knee Replacement patients in the country (over 600 to date). Don’t worry – 99% of those re-dos were referred to me! I published my results in the Journal of Bone and Joint Surgery in 2005. The most common source of failure of those knees sent to me was instability and the average time to revision was about 3 years! Instability causes pain, swelling and weakness. Your knee will be stable and, once you get your strength back, you will be able to ski, play tennis and even hike Kilamanjaro like one of my bilateral TKR patients did recently. That is if you are so inclined.
All TKRs remove the ACL so that ligament isn’t necessary. 50% of patients typically don’t have a function PCL so in those cases I use an implant with a post that “substitutes” for it. I have extensive experience with both types of implants. I think one of the things that separates me from most joint surgeons is that I treat knee replacement patients as individuals and “all total knee replacements are not alike!” I most frequently use the Smith & Nephew Knee System. They have the most sizing options, and their polyethylene has excellent wear characteristics. They also offer an oxinium coating on the femoral component to further reduce wear. I anticipate at least 25 years of solid use. When you see me again I will go over other technical aspects if you are interested. I appreciate your trust and am confident you will be happy you chose the Joint Replacement Center of Scottsdale. As the Director of the Joint Replacement Program at the hospital, I am biased, but I don’t think there is a better place to have a joint replacement done than Scottsdale Shea. And my staff is pretty good too!
Ted Firestone, MD