Healthy Cells, Healthy You with Janet Walker

The Revolutionary Jiffy Knee Procedure with Dr. Timothy Kavanaugh

• Janet Walker • Season 3 • Episode 1

Share episode

Discover the groundbreaking advancements in knee replacement surgery with Dr. Timothy Kavanaugh, a pioneering orthopedic surgeon in Scottsdale, Arizona.  Gain invaluable insights from Dr. Kavanaugh as he explains the traditional knee replacement process and brings an enlightening discussion on how Jiffy Knee, the newest total knee replacement surgical technique, is a game-changer for knee replacement patients.

Dr. Kavanaugh shares his journey of moving beyond traditional methods, highlighting the Jiffy Knee's promise of reduced recovery times and less pain due to its minimally invasive approach. 

We uncover how insurance coverage, expanding surgical expertise, and enthusiastic patient testimonials are contributing to Jiffy Knee's widespread acceptance. Compare the recovery experiences, noting the significant decrease in reliance on pain medication and assistive devices for those opting for the Jiffy Knee. Dr. Kavanaugh also offers a glimpse into the future, envisioning a world where this innovative procedure becomes the norm, transforming knee replacement surgery across all age groups. Join us for an inspiring conversation about redefining knee surgery for better patient experiences and outcomes.

To Learn More, Visit:
www.azortho.com
www.JiffyKnee.com

Together, we'll build Healthy Cells, and a Healthy You!

Janet Walker:

Our knees are there to support us in every step we take. We go through life not even thinking about them, until one day, a pop, a snap, an ouch or maybe it's more gradual an occasional ache that gets worse and worse and turns into a constant pain. What was once something you never thought about about suddenly becomes all you can think about. Today we're talking to one of the country's top experts in knees and we'll learn about the Jiffy Knee, a revolutionary new approach to knee replacement surgery that preserves soft tissue, minimizes trauma to the muscle and tendons and has been providing patients with significantly faster recovery and less post-surgery pain. It's giving knee replacement patients an amazing recovery story. If you suffer from knee pain or love someone that does, this is an episode you don't want to miss. It's a new season of Healthy Cells Healthy you.

Janet Walker:

I'm your host, Janet Walker. I've been working in the healthcare community for over 30 years and for 20 of those years I've also worked as a writer and producer for the Windsor Broadcasting award-winning national PBS, health information TV shows, American Health Journal and Innovations in Medicine. We've interviewed thousands of doctors, scientists and researchers on every topic related to health, medicine and medical technology. You can watch current episodes of Innovations in Medicine on your local PBS channel or you can stream our programs on the American Health Journal channel, the Better Health channel and TV Healthy Kids. Starting this season, I'll also be a new host for Windsor's award-winning podcast, better Wellness. Today's guest is renowned orthopedic surgeon Timothy Kavanaugh of AZ Ortho in Scottsdale, Arizona. Dr Cavanaugh is board certified and fellowship trained, specializing in the newest surgical and non-surgical treatments for knee, shoulder and hip pain. Dr Kavanaugh has performed over 8,000 joint replacement surgeries and over 1,000 Jiffy Knee procedures. Welcome to the show, Dr Kavanaugh.

Timothy Kavanaugh, MD:

Hi Janet, Thanks for having me.

Janet Walker:

So, according to the American Academy of Orthopedic Surgeons, 700,000 total knee replacements are performed in the United States every year, which surprised me. That's a lot, so that means there's a lot of patients trying to get their mobility and quality of life back. Let's start with some basics. Knee pain is a common complaint of people of all ages. What are some of the conditions that cause knee pain that no longer responds to conservative treatments?

Timothy Kavanaugh, MD:

So there's a variety of conditions that can lead to knee pain that end up causing people to see an orthopedic surgeon. Most of those are various forms of arthritis, which osteoarthritis is the main type of arthritis out there. That is the common wear and tear arthritis that we hear about. It is something that runs in families. I tell patients that probably at least 50% of arthritis diagnoses run in families, so there's a genetic component to it for sure, and then there's definitely a component that causes it to be accelerated from previous surgical conditions or knee injuries. Other conditions are rheumatoid arthritis, lupus arthritis, psoriatic arthritis, post-traumatic arthritis, which is when someone has a fracture, for example, that goes into a joint such as the knee. It gets fixed and heals, but there's always damage to the cartilage when that happens and that can lead to arthritis down the line. Those are probably the main ones that I see in the office.

Janet Walker:

Now, you've performed thousands of total knee replacements and it's not minor surgery. When is the right time for a patient to consider a surgical repair like total knee replacement?

Timothy Kavanaugh, MD:

That's a great question. I think that it is an answer that varies from patient to patient. I think you really have to take into account how much the knee is bothering you, how much it is slowing you down and not allowing you to live your life whether it's just with everyday activities or recreational activities or both and how much it's affecting your overall quality of life. And I think when you think about those aspects of it, that's when you can be confident that you're making the right decision to go ahead with knee replacement. After all, conservative means have been exhausted for treatment.

Janet Walker:

Let's talk about the procedure itself Now, before we discuss Jiffy Knee. What happens during traditional total knee replacement surgery?

Timothy Kavanaugh, MD:

So I would like to take that a step further back and just talk about what happens during knee replacement, because a lot of people have different ideas of what we actually do in there. So to start out with what a basic knee replacement does is it removes the worn out cartilage and basically the ends of the bone and replaces it with metal and plastic. So when you look at the knee, a lot of people think we make a cut, you know, five or six inches above the knee, five or six inches below the knee, and remove everything in between. And that's not the case. We're just taking off the ends of the bone, so probably at most like a quarter inch bone, and we're using all the rest of that bone to put our implants on. So that's one misconception I just want to start out with. It almost is a misnomer to call it a replacement. It'd be better to call it a resurfacing, in a way to better understand it for everybody, in a way to better understand it for everybody.

Timothy Kavanaugh, MD:

So traditional knee replacement versus jiffy knee. What happens in a traditional? And we all know patients who have that straight anterior incision right down the front of the knee. You see it every day and you probably have a lot of family or friends that have had it done and I used to do it. You know I did over 6,000 of them that way in my 21 years of doing them.

Timothy Kavanaugh, MD:

And under the skin you go through and cut the quad tendon or the quad muscle or some combination of both in order to get into the joint and you split it apart, you do the knee replacement and then you sew it back up on the way out and, knowing what I know now, having done that for 21 years and I don't do that anymore that approach is what I'm convinced causes most of the pain and disability after surgery. Because we don't see that with the jiffy knee. Most people, if you talk to them after traditional knee replacement surgery, would tell you that it was a pretty rough ride for the first three to six months, sometimes, especially during therapy sessions. And what the procedure now works on is that first three to six months where we're not seeing the suffering and we're seeing patients do a lot better, a lot quicker and get back to life quicker.

Janet Walker:

So then, are there different types of implants, and how do you select the right implant for each patient?

Timothy Kavanaugh, MD:

There are. There are multiple different types of implants. The basics of any knee implant are metal and plastic, which is high-density polyethylene. So the metal components are what is fixed to the bone on the end of the femur and top of the tibia. The plastic layer goes in between those two and is the bearing surface. And in most knee replacements there's a plastic button that goes on the underside of the kneecap that replaces the arthritis there, button that goes on the underside of the kneecap that replaces the arthritis there. The metal most commonly is titanium in the tibial component and an alloy of cobalt, chrome and nickel in the femoral component.

Timothy Kavanaugh, MD:

There are different variations of knee replacements that take into account different functions of the cruciate ligament. There's also different types of plastics that account for different geometries and stabilities of the knee and there's also knee replacements, for example, for people who have metal allergies and we can avoid using nickel, which is the common metal that people are usually allergic to. So we have a nickel-free implant that I use in some cases allergic to. So we have a nickel-free implant that I use in some cases.

Janet Walker:

So it really is a custom procedure. No two patients are exactly alike.

Timothy Kavanaugh, MD:

That is true, and no two knees in two patients are usually alike either. You know, there's subtle variations in the bone quality and the alignment and the soft tissue around the knee, the ligaments and tendons that can be tight in one knee and not tight in another knee, for example. So it really is kind of a unique procedure for each individual patient.

Janet Walker:

And then I've seen a lot of ads for robotic knee surgery. Do you use robotics in your practice, and is that necessary for a successful procedure?

Timothy Kavanaugh, MD:

So what that means is there are robots that are made by some of the orthopedic companies to put their implants in, and the robots help sense different alignments, different ligament tensions, and then they have a robot arm that comes in and helps the surgeon make the cuts. I don't use robotics. I've tried them all and I never really was satisfied with any particular system. I use something called computer navigation, which is a device that we affix to the end of the femur and top of the tibia during surgery. That measures the patient's alignment and helps me line up the implants that way.

Janet Walker:

Now, before you were trained in the Jiffy Knee technique, how many knee replacement procedures had you performed?

Timothy Kavanaugh, MD:

I've done over 6,000 primary total knee replacements.

Janet Walker:

That's a lot.

Timothy Kavanaugh, MD:

The traditional way. Yeah, that is a few. And overall pretty successful then Knee replacement is one of the most successful procedures in all medicine yes. So if you look at the literature, it has right around 85% outcomes of good and excellent results.

Janet Walker:

So then now let's get to the exciting stuff. Let's talk a little bit about Jiffy Knee, invented by Virginia orthopedic surgeon Manish Patel, and you were the first doctor outside of his own practice trained in the technique, certified in the technique. Is that correct?

Timothy Kavanaugh, MD:

That is correct.

Janet Walker:

So how did you learn about Jiffy Knee? What drew you to it, given that you've done so many successful traditional procedures?

Timothy Kavanaugh, MD:

It's a great question and it's kind of a funny story. I did not know Dr Patel before, about March of 2023. I have been pretty active on LinkedIn for a while now and he actually reached out to me on LinkedIn about it and I didn't know it at the time. But we have a mutual friend and our friend was one who told him when he decided he was going to start teaching this procedure. Our friend told him hey, you should probably call Kavanaugh and see if he's interested, because I've always kind of been interested in this kind of stuff throughout my career or something that would benefit patient recovery. So he did. He reached out to me and the first time he reached out I kind of ignored it. I thought it was kind of a goofy name and didn't think it was something that you know would have any significant benefit and you know. So I kind of ignored it and, to his credit, about a week or two later he reached out to me again. He said, hey, do me a favor, just look at the patient videos on my YouTube channel and then call me. And I thought, well, that's pretty confident of him.

Timothy Kavanaugh, MD:

So I got my interest and I went and looked at the videos. I couldn't believe what I saw. These patients are 24, 48 hours out from surgery and they're going up and down stairs, they're walking without any assistive devices and they look very comfortable. They're talking about not using any significant narcotics and I had never seen anything like this in my career. So I decided to go out and visit him and we flew out there and on the day I went to visit him we did eight of these in the OR and I got to see what he was doing, how this technique really works in the OR with retractor placement etc. Really works in the OR with retractor placement, et cetera. And I knew right away you know, I'd done enough knee surgery in my career that I can, technically, could do this procedure safely and reproduce it. Um, but what really sold me was, uh, I talked to the patients that day in the surgery center and there were two in particular that were coming back for their second knee and they're both about six weeks out from their first knee, which is also unheard of for the most part with traditional surgery, quick and one, yeah, very quick.

Timothy Kavanaugh, MD:

And I'll never forget this one older lady who told me when I asked her about it she said oh, I'll tell you exactly why? Why it's so great. And she lived in North Carolina, so she was about two hours away from where he is. People travel to go see him, or she told me. She's like, yeah, right away. When I went to PT, I was sitting in a room with a bunch of other people who had a traditional surgery and they were all hurting and I was able to do my PT and I wasn't hurting. And so she went up to each one of them and told them that you know, the reason you're hurting is because you had it the old way and I had the new way. And I thought to myself I'm like this lady here is telling me what I need to do, so I decided, on a plane ride on the way home, I'm like I gotta do this, it's too good. Um, and so we signed up and, uh, started doing a June 1st of 2023 and the rest is history, so to speak.

Timothy Kavanaugh, MD:

I mean we're. We're just over a thousand of them to date. Wow and uh, it's been pretty incredible.

Janet Walker:

I gotta say and so you're doing only Jiffy knee procedures, now for knee.

Timothy Kavanaugh, MD:

Since June 1st of last year I have done only the Jiffy knee technique on all of all of my knee patients. Yeah, it's too valuable to to not do on somebody. I feel, and everybody that I've seen has benefited from it.

Janet Walker:

Explain again exactly how Jiffy Knee differs from traditional knee replacement, and is it the same muscle sparing or minimally invasive procedure that you see a lot of ads for?

Timothy Kavanaugh, MD:

Good question. So the Jiffy Knee the incision's on the inside part of the knee, not straight in the front like traditional surgery, and I think that's where a huge advantage of it is not having that incision right on the front, because that hinders people's recovery when we're trying to bend the knee. If you think about it, that incision right on the front of the knee as you're trying to bend it is under tension which hurts. It's actually stretching the wound and when you come in on the inside and bend the knee it's actually relaxing. So that plays a role in it too. And when you come in from the side, you're able to go completely under the muscle and tendon with nothing being cut and it slides out of the way to do the surgery, slides back in place when we're done, with no compromise on my part of anything.

Timothy Kavanaugh, MD:

I need to see or angles, I need to measure or anything like that to put in the knee correctly, and then you have the benefit of having the entire muscle and tendon not cut. So the quad, sparing, muscle sparing, minimally invasive all those terms are very nondescript and you don't know for sure what people do in there. I've explored all of them in my career and nothing is like this, the jiffy knee. But what most of those entail are some variation of going in from the front and coming around under the skin, undermining all that, and then either minimally cutting into the muscle or going under it in a sub-vastus approach from the side, the difference being that the jiffy knee doesn't undermine any of the skin, so you don't have those big skin flaps that cause pain and swelling and bleeding underneath them too. So I think that's a major difference with the techniques.

Janet Walker:

So it is different For a patient to know for certain that they're getting the Jiffy Knee procedure. They need to what. Go to the Jiffy Knee website and make sure that their surgeon is on the list of certified Jiffy Knee providers. Is that how someone would know for certain that they're getting?

Timothy Kavanaugh, MD:

the Jiffy knee. Yeah, that's correct. Yes, that's the only way for sure to know that you're getting a Jiffy knee.

Janet Walker:

And then can any patient who's eligible for traditional knee surgery have the Jiffy Knee Procedure, or are there some patients that wouldn't be candidates for it?

Timothy Kavanaugh, MD:

So in my practice anyone who I think is a candidate for a knee replacement is a candidate for a Jiffy Knee Replacement. So I'm doing it in, as I mentioned, since June 1st last year I'm doing it in all my patients. I've even expanded it into my revision surgeries. So my redo patients Part of my practice because of what I do involves revision surgery probably about 20% of it and I felt early on that I could do the revisions through the in patients who have had previous traditional surgery with that anterior incision. So I started doing it and I found that I can successfully do it through the incision and these patients benefit from not having that tendon cut, just like the primary patients do.

Janet Walker:

So there's not a patient that's not eligible for , but they would be eligible for traditional surgery. Any patient who's eligible for traditional knee replacement surgery would still be a good candidate for .

Timothy Kavanaugh, MD:

Yeah, that's correct. Basically anybody who qualifies for a knee replacement is a Jiffy Knee candidate.

Janet Walker:

in my practice, With regard to pain, mobility and recovery after surgery. How does Jiffy Knee compare to traditional knee replacement surgery?

Timothy Kavanaugh, MD:

So what we see in the Jiffy Knee patients, by not cutting into the muscle and tendon, is significantly less pain right off the bat, and I think the best example of that is our narcotic use after these procedures. So traditionally, for 21 years I'm used to giving narcotics to total knee replacement patients, sometimes up to eight, 10 weeks afterwards, and so what we noticed in the Jiffy knee patients right away is everybody gets a one week prescription of oxycodone to go home with, and we're seeing probably 15 max 20% of the patients asking for a second narcotic prescription, so significantly less narcotics being prescribed, which is great in so many ways.

Janet Walker:

Oh, that's great.

Timothy Kavanaugh, MD:

There's a narcotic problem in our country. Nobody wants to be on those, nobody wants to contribute to it as a physician, and so we're doing something that, just by doing a procedure, causes less pain and less of a need for narcotics. So we're seeing this pain be managed quite readily with a combination of Tylenol and an anti-inflammatory medication, along with some post-op steroids early on and then an intermittent narcotic mixed in. What we're seeing with regards to rehab afterwards is the ability to participate in an active recovery really quick. You know we start with using the Romtech exercise bike that was designed specifically for knee rehab. We use that in almost all of our patients. It gets delivered to the house.

Timothy Kavanaugh, MD:

That's a three-week physical therapy program that you do five times a day on the bike and then we go to traditional outpatient PT at three weeks a day on the bike and then we go to traditional outpatient PT at three weeks. But we're seeing patients go for walks in a neighborhood with a cane or with nothing. You know that first weekend after surgery Driving a car is usually right around seven to 10 days. I have people playing golf like literally going out and playing 18 holes of golf three weeks out. That's happened numerous times Riding a bike outside, you know, a couple weeks after surgery.

Janet Walker:

Wow, pick a ball four or five weeks out.

Timothy Kavanaugh, MD:

You know things that you never, ever saw with traditional surgery.

Janet Walker:

Just knowing these things going into it must really help alleviate the fear factor that a lot of patients have. Just knowing that they're not going to have to be on narcotics after surgery for weeks and weeks must make people feel a lot better going into it.

Timothy Kavanaugh, MD:

I think it does confidence that what they know whether it was something they experienced themselves on one side and decided I'm not going to have the other side done, or they saw in a friend or a relative who went through it and, you know, thought, well, I'm not going to go through that, it's not worth it. They see these patients now recover with the jiffy knee and they think to themselves, okay, I can do this. And they're right. You know, when people come in and talk to me about it and say, okay, I think I can do this procedure, I tell them you can, you know, with confidence.

Janet Walker:

That's great.

Timothy Kavanaugh, MD:

And it's a nice thing to be able to tell the patients you know you're not going to see the suffering.

Janet Walker:

Nice. So does insurance and Medicare cover Jiffy Knee, just like it would cover traditional knee surgery.

Timothy Kavanaugh, MD:

Yes, that's a very common question that I get and as far as any insurance, including Medicare, is concerned, it is a total knee replacement, so there's no extra charges for it. There's nothing that will spill extra for the procedure itself, so it is covered just like a traditional surgery.

Janet Walker:

Now because there are relatively few surgeons in the US. If a patient's not Medicare yet, are they able to apply for out-of-network provider so that they can have a Jiffy Knee procedure. Would an insurance cover that?

Timothy Kavanaugh, MD:

So what we have seen and we're not only seeing patients local here in Arizona come in for this procedure, but we're seeing out-of-state patients who have different networks Blue Cross, blue Shield, New Mexico, Colorado, for example and so we're Blue Cross, blue Shield providers and so it is covered by those insurances. We're, on pretty much every plan, major insurance carrier, so we're not seeing any significant problems with that.

Janet Walker:

So I first saw a social media ad for Jiffy Knee about six months ago and the name looked a little goofy to me too. I assumed it was something kind of hokey, but then I clicked on the website and I thought, oh, this is a promising, really legitimate surgical procedure and lots of happy patient testimonials. So at that time, there were about a dozen surgeons trained throughout the country, and you, of course, being one of the first, and so when we first connected, you directed me to the Facebook patient group which had just been formed. I joined that group and there were about 100 patients. Now, just a few months later, about 100 patients. Now, just a few months later, there's double the original amount of surgeons that were there when I first went on the website, and that Facebook page has over 1100 members. So why do you think this procedure is getting such traction among doctors and patients?

Timothy Kavanaugh, MD:

That's a great question. I think that, first of all, with the surgeons, it's gaining traction because it's people who are interested in looking for a better way to do things, and that's what this comes down to for us. You know, changing surgical approaches for a surgeon from what you've been taught, I tell patients the closest thing I could give an example to is like changing religions. You know, it's something you kind of grew up with surgically. You learned on it. You do it that way because the people who are your mentors taught it to you that way and it works right. And even though knee replacement is a rough ride for a lot of people for a while, there's still really good long-term results and that's why it's always the mentality has been well, I'm going to do it this way because I know how to do it this way and it works and it gets good results long-term when you have an open mind and you can assess things and, as I mentioned earlier, and throughout my career, I've always kind of kept an open mind to look for things that are better, and so many things have come and gone by the wayside too. By the way, over 22 years now, you know and this just happens to be one that that's real. You know, it took 22, 21 years for me to find something like this, but here we are. You know you can, if you can, objectively look at this and say, yeah, this makes sense. Right, I can do this Technically, it's not going to put the patient at risk, or my skills are well in line with what I can do to accomplish this. Okay, let's go ahead and do it, and then you see these results, and that's what feeds the fire, right? This is about the patient results. Like I said, I don't get any extra money for doing this. This is just me putting this implant in differently, and then we're seeing these incredible patient results.

Timothy Kavanaugh, MD:

So now fast forward to the patient side of this, and the best part about this is it. This is patients telling other patients or you know, it's funny. At first, when I started doing this, this spread, you know. Okay, people would come in the office and I would tell them okay, I have this new technique I'm going to do that's going to give you a quicker recovery, less pain and less swelling.

Timothy Kavanaugh, MD:

And so I had to talk them through the entire procedure why it's different and why it's not a risky thing. You know, we can safely do this for them. And then we started seeing okay, well, now I heard about Ms Smith, who had one done, you know, or Ms Jones, they're my neighbor, okay, and I want what she had, okay. So that started happening in the first couple of months. And then, and there's the Facebook ads and the Facebook talks. You mentioned that I do. I do a seminar about every six to eight weeks on Facebook which is a live Q&A, and those have gotten more and more popular and it's a great way to connect with patients and answer questions and I think the patients really appreciate that.

Timothy Kavanaugh, MD:

But now we're starting to see, like one of the funny ones that I it's like that six degrees of separation thing. You know, this was about six weeks ago. I saw a patient who said, yeah, degrees, five degrees away from this patient was sitting in front of me and she was like oh yeah. So I called that guy and he told me that you know, this is the greatest thing and I need to get one of these. And you know it's nice that the patients are out there with real life experiences in it, knowing that they're getting a full knee replacement, which is what solves the problem of the arthritis, and they don't have all that suffering to go with it. It's another funny story One of my earlier patients I had here, one of my neighbors.

Timothy Kavanaugh, MD:

I did his surgery the week before the 4th of July, so end of June 2023. So he was in the first 15 patients probably, and so he had a surgery four days before the 4th of July. He went to a 4th of July party down the street and he walked in and left his walker at the front door and he was walking around mingling with everybody. And there was another doctor at the party who was an anesthesiologist who couldn't believe it that he had just had knee replacement surgery. And the guy actually told him you don't know what surgery you had because you couldn't have had a knee replacement. You wouldn't be walking around, you'd be hurting a lot more. So I thought that was kind of funny that somebody else who didn't know what the patient had told him oh, you couldn't have had a knee replacement. But we've heard that over and over again.

Janet Walker:

Well, you've definitely got a lot of happy patients on that Facebook group and, just for comparison, I joined another knee surgery Facebook group that was just like a traditional knee replacement Facebook group and what a difference in terms of how people feel about the procedure post-operatively and what they're experiencing. And, like you said, people. Well, there was someone that was climbing a mountain seven weeks past surgery one of your patients in Arizona and people on the other group are still using a walker at seven weeks post-op. So yeah, it seems like it's a huge difference in how patients are recovering. Let's talk a little bit about post-op recovery and compare traditional surgery to Jiffy Knee. So hospital stay, inpatient or outpatient.

Timothy Kavanaugh, MD:

Jiffy knee. So hospital stay, inpatient or outpatient. Jiffy Knee is 85% outpatient, which is great, so you get to go home. You sleep in your own bed the night of surgery. There's a lot of disadvantages to being in a hospital after an elective joint replacement. First and foremost there's infections in hospitals of various types and you know, the last thing anybody wants after a clean hip or knee replacement is an infection. That's a big deal avoiding by going home the same day. And then you know just the PT recovery we have now for this, I believe, is just top notch and it's part of what contributes to why these results are so good by having that exercise bike at home that the patients do the program on and it makes a big difference in post-operative pain, post-operative swelling and just the post-operative mobility.

Janet Walker:

Nice and some of these things we've touched upon, but I'm going to ask a few of them again. So, post-op pain medication, typically with Jiffy Knee, how many days versus traditional, how many days?

Timothy Kavanaugh, MD:

stop Jiffy Knee patients. Everybody gets a week's worth of oxycodone. Most people don't use the whole prescription and about 15% of patients ask for a second one, whereas with traditional surgery it's really common to still be giving narcotics to people six to eight weeks out, sometimes 10 weeks out, especially around the time of PT. Now the other medications we use to help with post-op pain Tylenol is a staple after the Jiffy Knee, as is an anti-inflammatory, whether that's a prescription strength one or a lot of people end up using ibuprofen or Advil, I believe. And then we do use post-operative steroids to help control swelling.

Janet Walker:

A need for assistive devices like walkers, crutches or canes Jiffy Knee versus traditional.

Timothy Kavanaugh, MD:

So everybody goes home from the hospital or surgery center with a walker. Some people use it for a day, some people use it for a couple days or a week, some people use it for two weeks, some people use it for a couple days or a week, some people use it for two weeks and then go to a cane, and there's plenty of people who go through that progression and end up using nothing, you know, three or four days out. Some people are still on a cane in two weeks. It really depends on a couple things. One main thing is what is the shape of the leg prior to surgery? You know, if you have significant quad weakness it's going to be harder to progress, obviously because the muscle has to build back up, just like anything else in life. And then the individual swelling response after surgery. You know, some people we still see, even with , get a pretty significant swelling response and that's more individualized on how your body responds to the surgery itself. We do a couple of things to really kind of help prevent swelling afterwards and I think it's been effective. But once in a while you still see somebody who's got some pretty significant swelling and that just slows down the recovery a little bit Now with comparing that to my experience with traditional surgery.

Timothy Kavanaugh, MD:

You know people were minimum on a walker for two, three weeks. Usually. It was extremely rare to ever see somebody who would progress that okay. I was off my walker in a couple of days and on a cane, you know it just, we call them unicorn couple of days and on a cane. You know it just, we call them unicorns because they were that rare that you know we just didn't see a lot and so we're just seeing that progression.

Timothy Kavanaugh, MD:

And then the other point of data that we look at a lot and compare is that that three week mark when the Jiffy Knee patients now are going to outpatient physical therapy. So that's their first contact with an objective outside observer or physical therapist who has a lot of experience with rehabbing knees. And we're just hearing these reports from physical therapists around the Valley that when these patients show up, you know we're just amazed at what kind of motion they have already, how easy it is to work with them because they don't have a ton of pain, they don't have a ton of swelling and they're just way ahead of where a traditional three-week post-op knee patient is. You know they're not having that suffering still, like a lot of them are, and that's all due to not cutting into that tendon. I'm completely convinced of that.

Janet Walker:

How important is physical therapy to recovery?

Timothy Kavanaugh, MD:

So PT after knee replacement surgery is still incredibly important, at least probably 30-40% of the whole entire procedure.

Timothy Kavanaugh, MD:

You know, if you look at the whole picture, 30, 40% of the whole entire procedure. You know, if you look at the whole picture you know pretty much everybody needs some strengthening after one of these because they come into the surgery with muscle that isn't quite up to strength, you know, because you have an arthritic knee. And you know the therapists also are the coaches. After all this. They're looking at each individual patient and thinking about how we can maximize the result and that's what helps everybody get the best happy results here, you know.

Timothy Kavanaugh, MD:

So therapy, as I mentioned now with this protocol using the RomTech bike, is great because at home it's doing five sessions a day for three weeks and that's something we monitor in the office. And then we switch you over to outpatient PT and pretty much everybody has that. There's probably about it's less than 10% of the patients who insurance doesn't cover the RomTech and they end up going right to PT. But that's still a great alternative. You alternative getting in with a PT right away and working with them to get the range of motion and strengthening.

Janet Walker:

How would you say that Jiffy Knee figures into the future of knee replacement surgery?

Timothy Kavanaugh, MD:

It's a great question. I think that, knowing what I know and seeing how reproducible this procedure is, and then what kind of results you get from it, patient after patient, and let me say that I think you know in medicine we treat patients, we don't treat robots or automobiles. So you know it's individuals that we're taking care of, right, no matter what we're doing and what field of medicine. So not everybody behaves the same way with any given procedure or intervention, any medication. You know so. But what I think does for the entire population of knee replacement patients is it takes the bar and moves it way up for their recovery. And that's why when I tell patients you know what's it going to do for them, I tell them it's going to improve. You know your life, in a sense that you know the recovery is going to be significantly better for you. The recovery is going to be significantly better for you and your pain is going to be significantly less relative to what I know for 21 years doing traditional surgery. So this is a huge leap forward. I think, and I foresee in probably five to seven years, that this will be the dominant way to put in knee replacements. It's here to stay. It's going to keep growing.

Timothy Kavanaugh, MD:

You know surgeons are slow to adopt things. As I mentioned earlier, it's a big deal to change surgical approaches, but I think once more people learn about this and see the results in patients and get inspired to actually start doing it, they'll see that you know quality, technical, technical quality good surgeons can do this reproducibly and get great results. This is going to expand and so we're going to see this spread around the country and some exciting news here in the Valley. You know we just um are going to hire another surgeon in our group, an experienced joint, hip and knee replacement surgeon, to join us starting in January. He's going to join our group and he's going to be in an office that we're going to have out West in the Sun City area just to have another provider here who can give this procedure to patients.

Timothy Kavanaugh, MD:

And I just you know things are busy for me and it's great, but I also, you know, look at it as from a patient perspective that you know I don't think it's fair to wait forever for something like this, even though it's very good and I think it's worth waiting for. So in my mindset, I want to make this available to more patients, and so we're always around here going to look to expand this and get more people taken care of with it. So that's my philosophy and that's how I want to look at it. So that's why we're adding another surgeon already. You know, with me being 18 months into this, knowing how good it is and seeing into patients, so we're going to keep expanding this and offering it to more and more patients.

Janet Walker:

Oh, that is exciting news. That is really exciting news. Yeah, what about age range? What's the youngest?

Timothy Kavanaugh, MD:

patient, so the age range is from 26 to 94.

Janet Walker:

Wow.

Timothy Kavanaugh, MD:

Yeah, so in my entire career the youngest patient I ever have done a knee replacement on was 25. Jiffy needs 26. And so those are patients when you get down into the twenties and thirties, um, who need knee replacements. Those are patients who have some congenital problem, uh, post-traumatic problem. You know they had a bad fracture and it didn't heal. Um had a bad infection, uh, when they were young and their cartilage got destroyed, or some, you know, juvenile rheumatoid arthritis. That's another one that comes into play when you have the younger side.

Timothy Kavanaugh, MD:

The oldest patient I've ever done knee replacements in is a 96 year old lady. Um, that was when I was up in Alaska. So the oldest Jiffy is 94. Um, and you know this is a lady who you know couldn't hike anymore. She used to hike every day up in Alaska and she got to a point where her knees weren't letting her do that. So you know she was healthy and we did knee replacements in her. You know one at a time. And the interesting thing is that you know age especially. I found around here in Arizona. You know there's so many healthy 90,. I found around here in Arizona. You know there's so many healthy 90, high eighties and 90 year olds, you know. So age really isn't a limiting factor, it's really your overall health condition.

Janet Walker:

So it's available, that's. That's really a great thing to hear that even people that are in their eighties or nineties are able to get this procedure and have some mobility and quality of life and relief from pain, even in those later years.

Timothy Kavanaugh, MD:

It is a great feeling to be able to offer to patients Yep.

Janet Walker:

Dr Kavanaugh, thank you so much for being with us and educating us about total knee replacement and especially about the procedure.

Timothy Kavanaugh, MD:

Yeah, thank you.

Janet Walker:

It's such an important topic for so many Americans and I hope I can talk to you again about this or another orthopedic issue that so many people want to learn about. Certainly, listeners, you can schedule an appointment to see Dr Kavanaugh and the other MDs at AZ Ortho in his Scottsdale, arizona or new West Valley office, or learn more about the Jiffy Knee procedure online at azortho. com or jiffyknee. com. That's J-I-F-F-Y-K-N-E-E. com. I'll have links to both websites in the show notes on the podcast website at healthyCellsPodcast. com. Stay tuned for more episodes in my knee replacement series featuring one of the country's leading physical therapists in knee replacement recovery. Thanks so much for listening to the Healthy Cells Healthy you podcast with me, your host, Janet Walker. You can find us on Apple Podcasts, google Podcasts iHeart radio , Spotify or wherever you get your podcasts. Subscribe and tell your friends. We'll help you find solutions and together we'll build a healthier you.

People on this episode

Head Shot

Janet Walker

Host