October 23, 2024 • 43 mins
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!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Janet Walker (00:03):
Our knees are there to support us in every
step we take.
We go through life not eventhinking about them, until one
day, a pop, a snap, an ouch ormaybe it's more gradual an
occasional ache that gets worseand worse and turns into a
constant pain.
What was once something younever thought about about
(00:25):
suddenly becomes all you canthink about.
Today we're talking to one ofthe country's top experts in
knees and we'll learn about theJiffy Knee, a revolutionary new
approach to knee replacementsurgery that preserves soft
tissue, minimizes trauma to themuscle and tendons and has been
providing patients withsignificantly faster recovery
(00:46):
and less post-surgery pain.
It's giving knee replacementpatients an amazing recovery
story.
If you suffer from knee pain orlove someone that does, this is
an episode you don't want tomiss.
It's a new season of HealthyCells Healthy you.
I'm your host, Janet Walker.
I've been working in thehealthcare community for over 30
(01:08):
years and for 20 of those yearsI've also worked as a writer
and producer for the WindsorBroadcasting award-winning
national PBS, health informationTV shows, American Health
Journal and Innovations inMedicine.
We've interviewed thousands ofdoctors, scientists and
researchers on every topicrelated to health, medicine and
(01:28):
medical technology.
You can watch current episodesof Innovations in Medicine on
your local PBS channel or youcan stream our programs on the
American Health Journal channel,the Better Health channel and
TV Healthy Kids.
Starting this season, I'll alsobe a new host for Windsor's
award-winning podcast, betterWellness.
Today's guest is renownedorthopedic surgeon Timothy
(01:51):
Kavanaugh of AZ Ortho inScottsdale, Arizona.
Dr Cavanaugh is board certifiedand fellowship trained,
specializing in the newestsurgical and non-surgical
treatments for knee, shoulderand hip pain.
Dr Kavanaugh has performed over8,000 joint replacement
surgeries and over 1,000 JiffyKnee procedures.
Welcome to the show, DrKavanaugh.
Timothy Kavanaugh, MD (02:14):
Hi Janet, Thanks for having me.
Janet Walker (02:16):
So, according to the American Academy of
Orthopedic Surgeons, 700,000total knee replacements are
performed in the United Statesevery year, which surprised me.
That's a lot, so that meansthere's a lot of patients trying
to get their mobility andquality of life back.
Let's start with some basics.
Knee pain is a common complaintof people of all ages.
(02:39):
What are some of the conditionsthat cause knee pain that no
longer responds to conservativetreatments?
Timothy Kavanaugh, MD (02:46):
So there's a variety of conditions
that can lead to knee pain thatend up causing people to see an
orthopedic surgeon.
Most of those are various formsof arthritis, which
osteoarthritis is the main typeof arthritis out there.
(03:06):
That is the common wear andtear arthritis that we hear
about.
It is something that runs infamilies.
I tell patients that probablyat least 50% of arthritis
diagnoses run in families, sothere's a genetic component to
it for sure, and then there'sdefinitely a component that
(03:28):
causes it to be accelerated fromprevious surgical conditions or
knee injuries.
Other conditions are rheumatoidarthritis, 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.
(03:48):
It gets fixed and heals, butthere's always damage to the
cartilage when that happens andthat can lead to arthritis down
the line.
Those are probably the mainones that I see in the office.
Janet Walker (04:02):
Now, you've performed thousands of total
knee replacements and it's notminor surgery.
When is the right time for apatient to consider a surgical
repair like total kneereplacement?
Timothy Kavanaugh, MD (04:15):
That's a great question.
I think that it is an answerthat varies from patient to
patient.
I think you really have to takeinto account how much the knee
is bothering you, how much it isslowing you down and not
allowing you to live your lifewhether it's just with everyday
activities or recreationalactivities or both and how much
(04:39):
it's affecting your overallquality of life.
And I think when you thinkabout those aspects of it,
that's when you can be confidentthat you're making the right
decision to go ahead with kneereplacement.
After all, conservative meanshave been exhausted for
treatment.
Janet Walker (04:56):
Let's talk about the procedure itself Now, before
we discuss Jiffy Knee.
What happens during traditionaltotal knee replacement surgery?
Timothy Kavanaugh, MD (05:05):
So I would like to take that a step
further back and just talk aboutwhat happens during knee
replacement, because a lot ofpeople have different ideas of
what we actually do in there.
So to start out with what abasic knee replacement does is
it removes the worn outcartilage and basically the ends
(05:27):
of the bone and replaces itwith metal and plastic.
So when you look at the knee, alot of people think we make a
cut, you know, five or sixinches above the knee, five or
six inches below the knee, andremove everything in between.
And that's not the case.
We're just taking off the endsof the bone, so probably at most
like a quarter inch bone, andwe're using all the rest of that
(05:49):
bone to put our implants on.
So that's one misconception Ijust want to start out with.
It almost is a misnomer to callit a replacement.
It'd be better to call it aresurfacing, in a way to better
understand it for everybody, ina way to better understand it
for everybody.
So traditional knee replacementversus jiffy knee.
What happens in a traditional?
(06:14):
And we all know patients whohave that straight anterior
incision right down the front ofthe knee.
You see it every day and youprobably have a lot of family or
friends that have had it doneand I used to do it.
You know I did over 6,000 ofthem that way in my 21 years of
doing them.
And under the skin you gothrough and cut the quad tendon
or the quad muscle or somecombination of both in order to
(06:37):
get into the joint and you splitit apart, you do the knee
replacement and then you sew itback up on the way out and,
knowing what I know now, havingdone that for 21 years and I
don't do that anymore thatapproach is what I'm convinced
(07:00):
causes most of the pain anddisability after surgery.
Because we don't see that withthe jiffy knee.
Most people, if you talk tothem after traditional knee
replacement surgery, would tellyou that it was a pretty rough
ride for the first three to sixmonths, sometimes, especially
during therapy sessions.
And what the procedure nowworks on is that first three to
six months where we're notseeing the suffering and we're
(07:23):
seeing patients do a lot better,a lot quicker and get back to
life quicker.
Janet Walker (07:28):
So then, are there different types of implants,
and how do you select the rightimplant for each patient?
Timothy Kavanaugh, MD (07:35):
There are .
There are multiple differenttypes of implants.
The basics of any knee implantare metal and plastic, which is
high-density polyethylene.
So the metal components arewhat is fixed to the bone on the
end of the femur and top of thetibia.
The plastic layer goes inbetween those two and is the
(07:56):
bearing surface.
And in most knee replacementsthere's a plastic button that
goes on the underside of thekneecap that replaces the
arthritis there, button thatgoes on the underside of the
kneecap that replaces thearthritis there.
The metal most commonly istitanium in the tibial component
and an alloy of cobalt, chromeand nickel in the femoral
(08:18):
component.
There are different variationsof knee replacements that take
into account different functionsof the cruciate ligament.
There's also different types ofplastics that account for
different geometries andstabilities of the knee and
there's also knee replacements,for example, for people who have
metal allergies and we canavoid using nickel, which is the
common metal that people areusually allergic to.
(08:40):
So we have a nickel-freeimplant that I use in some cases
allergic to.
So we have a nickel-freeimplant that I use in some cases
.
Janet Walker (08:45):
So it really is a custom procedure.
No two patients are exactlyalike.
Timothy Kavanaugh, MD (08:57):
That is true, and no two knees in two
patients are usually alikeeither.
You know, there's subtlevariations in the bone quality
and the alignment and the softtissue around the knee, the
ligaments and tendons that canbe tight in one knee and not
tight in another knee, forexample.
So it really is kind of aunique procedure for each
individual patient.
Janet Walker (09:14):
And then I've seen a lot of ads for robotic knee
surgery.
Do you use robotics in yourpractice, and is that necessary
for a successful procedure?
Timothy Kavanaugh, MD (09:26):
So what that means is there are robots
that are made by some of theorthopedic companies to put
their implants in, and therobots help sense different
alignments, different ligamenttensions, and then they have a
robot arm that comes in andhelps the surgeon make the cuts.
I don't use robotics.
(09:48):
I've tried them all and I neverreally was satisfied with any
particular system.
I use something called computernavigation, which is a device
that we affix to the end of thefemur and top of the tibia
during surgery.
That measures the patient'salignment and helps me line up
the implants that way.
Janet Walker (10:08):
Now, before you were trained in the Jiffy Knee
technique, how many kneereplacement procedures had you
performed?
Timothy Kavanaugh, MD (10:16):
I've done over 6,000 primary total knee
replacements.
Janet Walker (10:21):
That's a lot.
Timothy Kavanaugh, MD (10:22):
The traditional way.
Yeah, that is a few.
And overall pretty successfulthen Knee replacement is one of
the most successful proceduresin all medicine yes.
So if you look at theliterature, it has right around
85% outcomes of good andexcellent results.
Janet Walker (10:41):
So then now let's get to the exciting stuff.
Let's talk a little bit aboutJiffy Knee, invented by Virginia
orthopedic surgeon Manish Patel, and you were the first doctor
outside of his own practicetrained in the technique,
certified in the technique.
Is that correct?
Timothy Kavanaugh, MD (11:00):
That is correct.
Janet Walker (11:01):
So how did you learn about Jiffy Knee?
What drew you to it, given thatyou've done so many successful
traditional procedures?
Timothy Kavanaugh, MD (11:10):
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 onLinkedIn for a while now and he
actually reached out to me onLinkedIn about it and I didn't
(11:33):
know it at the time.
But we have a mutual friend andour friend was one who told him
when he decided he was going tostart teaching this procedure.
Our friend told him hey, youshould probably call Kavanaugh
and see if he's interested,because I've always kind of been
interested in this kind ofstuff throughout my career or
something that would benefitpatient recovery.
So he did.
(11:54):
He reached out to me and thefirst time he reached out I kind
of ignored it.
I thought it was kind of agoofy name and didn't think it
was something that you knowwould have any significant
benefit and you know.
So I kind of ignored it and, tohis credit, about a week or two
later he reached out to meagain.
He said, hey, do me a favor,just look at the patient videos
(12:17):
on my YouTube channel and thencall me.
And I thought, well, that'spretty confident of him.
So I got my interest and I wentand looked at the videos.
I couldn't believe what I saw.
These patients are 24, 48 hoursout from surgery and they're
going up and down stairs,they're walking without any
(12:37):
assistive devices and they lookvery comfortable.
They're talking about not usingany significant narcotics and I
had never seen anything likethis in my career.
So I decided to go out andvisit him and we flew out there
and on the day I went to visithim we did eight of these in the
OR and I got to see what he wasdoing, how this technique
(13:00):
really works in the OR withretractor placement etc.
Really works in the OR withretractor 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 reproduceit.
Um, but what really sold me was, uh, I talked to the patients
that day in the surgery centerand there were two in particular
(13:22):
that were coming back for theirsecond knee and they're both
about six weeks out from theirfirst knee, which is also
unheard of for the most partwith traditional surgery, quick
and one, yeah, very quick.
And I'll never forget this oneolder lady who told me when I
(13:42):
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, orshe told me.
She's like, yeah, right away.
When I went to PT, I wassitting in a room with a bunch
of other people who had atraditional surgery and they
were all hurting and I was ableto do my PT and I wasn't hurting
(14:05):
.
And so she went up to each oneof them and told them that you
know, the reason you're hurtingis because you had it the old
way and I had the new way.
And I thought to myself I'mlike this lady here is telling
me what I need to do, so Idecided, on a plane ride on the
way home, I'm like I gotta dothis, it's too good.
Um, and so we signed up and, uh, started doing a June 1st of
(14:30):
2023 and the rest is history, soto speak.
I mean we're.
We're just over a thousand ofthem to date.
Wow and uh, it's been prettyincredible.
Janet Walker (14:42):
I gotta say and so you're doing only Jiffy knee
procedures, now for knee.
Timothy Kavanaugh, MD (14:47):
Since June 1st of last year I have
done only the Jiffy kneetechnique on all of all of my
knee patients.
Yeah, it's too valuable to tonot do on somebody.
I feel, and everybody that I'veseen has benefited from it.
Janet Walker (15:04):
Explain again exactly how Jiffy Knee differs
from traditional kneereplacement, and is it the same
muscle sparing or minimallyinvasive procedure that you see
a lot of ads for?
Timothy Kavanaugh, MD (15:19):
Good question.
So the Jiffy Knee theincision's on the inside part of
the knee, not straight in thefront like traditional surgery,
and I think that's where a hugeadvantage of it is not having
that incision right on the front, because that hinders people's
recovery when we're trying tobend the knee.
If you think about it, thatincision right on the front of
(15:41):
the knee as you're trying tobend it is under tension which
hurts.
It's actually stretching thewound and when you come in on
the inside and bend the kneeit's actually relaxing.
So that plays a role in it too.
And when you come in from theside, you're able to go
completely under the muscle andtendon with nothing being cut
and it slides out of the way todo the surgery, slides back in
(16:04):
place when we're done, with nocompromise on my part of
anything.
I need to see or angles, I needto measure or anything like that
to put in the knee correctly,and then you have the benefit of
having the entire muscle andtendon not cut.
So the quad, sparing, musclesparing, minimally invasive all
those terms are very nondescriptand you don't know for sure
(16:26):
what people do in there.
I've explored all of them in mycareer and nothing is like this
, the jiffy knee.
But what most of those entailare some variation of going in
from the front and coming aroundunder the skin, undermining all
that, and then either minimallycutting into the muscle or
(16:47):
going under it in a sub-vastusapproach from the side, the
difference being that the jiffyknee doesn't undermine any of
the skin, so you don't havethose big skin flaps that cause
pain and swelling and bleedingunderneath them too.
So I think that's a majordifference with the techniques.
Janet Walker (17:06):
So it is different For a patient to know for
certain that they're getting theJiffy Knee procedure.
They need to what.
Go to the Jiffy Knee websiteand make sure that their surgeon
is on the list of certifiedJiffy Knee providers.
Is that how someone would knowfor certain that they're getting
(17:28):
?
Timothy Kavanaugh, MD (17:28):
the Jiffy knee.
Yeah, that's correct.
Yes, that's the only way forsure to know that you're getting
a Jiffy knee.
Janet Walker (17:37):
And then can any patient who's eligible for
traditional knee surgery havethe Jiffy Knee Procedure, or are
there some patients thatwouldn't be candidates for it?
Timothy Kavanaugh, MD (17:48):
So in my practice anyone who I think is a
candidate for a kneereplacement is a candidate for a
Jiffy Knee Replacement.
So I'm doing it in, as Imentioned, since June 1st last
year I'm doing it in all mypatients.
I've even expanded it into myrevision surgeries.
So my redo patients Part of mypractice because of what I do
(18:12):
involves revision surgeryprobably about 20% of it and I
felt early on that I could dothe revisions through the in
patients who have had previoustraditional surgery with that
anterior incision.
So I started doing it and Ifound that I can successfully do
it through the incision andthese patients benefit from not
(18:36):
having that tendon cut, justlike the primary patients do.
Janet Walker (18:41):
So there's not a patient that's not eligible for
, but they would be eligible fortraditional surgery.
Any patient who's eligible fortraditional knee replacement
surgery would still be a goodcandidate for .
Timothy Kavanaugh, MD (18:58):
Yeah, that's correct.
Basically anybody who qualifiesfor a knee replacement is a
Jiffy Knee candidate.
Janet Walker (19:06):
in my practice, With regard to pain, mobility
and recovery after surgery.
How does Jiffy Knee compare totraditional knee replacement
surgery?
Timothy Kavanaugh, MD (19:19):
So what we see in the Jiffy Knee
patients, by not cutting intothe muscle and tendon, is
significantly less pain rightoff the bat, and I think the
best example of that is ournarcotic use after these
procedures.
So traditionally, for 21 yearsI'm used to giving narcotics to
(19:40):
total knee replacement patients,sometimes up to eight, 10 weeks
afterwards, and so what wenoticed in the Jiffy knee
patients right away is everybodygets a one week prescription of
oxycodone to go home with, andwe're seeing probably 15 max 20%
of the patients asking for asecond narcotic prescription, so
(20:03):
significantly less narcoticsbeing prescribed, which is great
in so many ways.
Janet Walker (20:07):
Oh, that's great.
Timothy Kavanaugh, MD (20:08):
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'redoing something that, just by
doing a procedure, causes lesspain and less of a need for
narcotics.
So we're seeing this pain bemanaged quite readily with a
combination of Tylenol and ananti-inflammatory medication,
(20:30):
along with some post-op steroidsearly on and then an
intermittent narcotic mixed in.
What we're seeing with regardsto rehab afterwards is the
ability to participate in anactive recovery really quick.
You know we start with usingthe Romtech exercise bike that
was designed specifically forknee rehab.
(20:51):
We use that in almost all ofour patients.
It gets delivered to the house.
That's a three-week physicaltherapy program that you do five
times a day on the bike andthen we go to traditional
outpatient PT at three weeks aday on the bike and then we go
to traditional outpatient PT atthree weeks.
But we're seeing patients gofor walks in a neighborhood with
a cane or with nothing.
You know that first weekendafter surgery Driving a car is
(21:17):
usually right around seven to 10days.
I have people playing golf likeliterally going out and playing
18 holes of golf three weeksout.
That's happened numerous timesRiding a bike outside, you know,
a couple weeks after surgery.
Janet Walker (21:33):
Wow, pick a ball four or five weeks out.
Timothy Kavanaugh, MD (21:35):
You know things that you never, ever saw
with traditional surgery.
Janet Walker (21:39):
Just knowing these things going into it must
really help alleviate the fearfactor that a lot of patients
have.
Just knowing that they're notgoing to have to be on narcotics
after surgery for weeks andweeks must make people feel a
lot better going into it.
Timothy Kavanaugh, MD (21:56):
I think it does confidence that what
they know whether it wassomething they experienced
themselves on one side anddecided I'm not going to have
the other side done, or they sawin 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 worthit.
(22:16):
They see these patients nowrecover with the jiffy knee and
they think to themselves, okay,I can do this.
And they're right.
You know, when people come inand talk to me about it and say,
okay, I think I can do thisprocedure, I tell them you can,
you know, with confidence.
Janet Walker (22:31):
That's great.
Timothy Kavanaugh, MD (22:32):
And it's a nice thing to be able to tell
the patients you know you're notgoing to see the suffering.
Janet Walker (22:36):
Nice.
So does insurance and Medicarecover Jiffy Knee, just like it
would cover traditional kneesurgery.
Timothy Kavanaugh, MD (22:45):
Yes, that's a very common question
that I get and as far as anyinsurance, including Medicare,
is concerned, it is a total kneereplacement, so there's no
extra charges for it.
There's nothing that will spillextra for the procedure itself,
so it is covered just like atraditional surgery.
Janet Walker (23:07):
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 thatthey can have a Jiffy Knee
procedure.
Would an insurance cover that?
Timothy Kavanaugh, MD (23:25):
So what we have seen and we're not only
seeing patients local here inArizona come in for this
procedure, but we're seeingout-of-state patients who have
different networks Blue Cross,blue Shield, New Mexico,
Colorado, for example and sowe're Blue Cross, blue Shield
providers and so it is coveredby those insurances.
(23:47):
We're, on pretty much everyplan, major insurance carrier,
so we're not seeing anysignificant problems with that.
Janet Walker (23:57):
So I first saw a social media ad for Jiffy Knee
about six months ago and thename looked a little goofy to me
too.
I assumed it was something kindof hokey, but then I clicked on
the website and I thought, oh,this is a promising, really
legitimate surgical procedureand lots of happy patient
(24:20):
testimonials.
So at that time, there wereabout a dozen surgeons trained
throughout the country, and you,of course, being one of the
first, and so when we firstconnected, you directed me to
the Facebook patient group whichhad just been formed.
I joined that group and therewere about 100 patients.
(24:41):
Now, just a few months later,about 100 patients.
Now, just a few months later,there's double the original
amount of surgeons that werethere when I first went on the
website, and that Facebook pagehas over 1100 members.
So why do you think thisprocedure is getting such
traction among doctors andpatients?
Timothy Kavanaugh, MD (25:03):
That's a great question.
I think that, first of all,with the surgeons, it's gaining
traction because it's people whoare interested in looking for a
better way to do things, andthat's what this comes down to
for us.
You know, changing surgicalapproaches for a surgeon from
what you've been taught, I tellpatients the closest thing I
(25:24):
could give an example to is likechanging religions.
You know, it's something youkind of grew up with surgically.
You learned on it.
You do it that way because thepeople who are your mentors
taught it to you that way and itworks right.
And even though kneereplacement is a rough ride for
a lot of people for a while,there's still really good
(25:47):
long-term results and that's whyit's always the mentality has
been well, I'm going to do itthis way because I know how to
do it this way and it works andit gets good results long-term
when you have an open mind andyou can assess things and, as I
mentioned earlier, andthroughout my career, I've
always kind of kept an open mindto look for things that are
(26:08):
better, and so many things havecome 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 yearsfor 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 thisTechnically, it's not going to
(26:29):
put the patient at risk, or myskills 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 patientresults.
Like I said, I don't get anyextra money for doing this.
This is just me putting thisimplant in differently, and then
(26:55):
we're seeing these incrediblepatient results.
So now fast forward to thepatient side of this, and the
best part about this is it.
This is patients telling otherpatients or you know, it's funny
.
At first, when I started doingthis, this spread, you know.
Okay, people would come in theoffice and I would tell them
(27:17):
okay, I have this new techniqueI'm going to do that's going to
give you a quicker recovery,less pain and less swelling.
And so I had to talk themthrough the entire procedure why
it's different and why it's nota risky thing.
You know, we can safely do thisfor them.
And then we started seeing okay, well, now I heard about Ms
(27:38):
Smith, who had one done, youknow, or Ms Jones, they're my
neighbor, okay, and I want whatshe had, okay.
So that started happening inthe first couple of months.
And then, and there's theFacebook ads and the Facebook
talks.
You mentioned that I do.
I do a seminar about every sixto eight weeks on Facebook which
is a live Q&A, and those havegotten more and more popular and
(28:00):
it's a great way to connectwith patients and answer
questions and I think thepatients really appreciate that.
But now we're starting to see,like one of the funny ones that
I it's like that six degrees ofseparation thing.
You know, this was about sixweeks ago.
(28:31):
I saw a patient who said, yeah,degrees, five degrees away from
this patient was sitting infront of me and she was like oh
yeah.
So I called that guy and hetold me that you know, this is
the greatest thing and I need toget one of these.
And you know it's nice that thepatients are out there with
real life experiences in it,knowing that they're getting a
full knee replacement, which iswhat solves the problem of the
(28:53):
arthritis, and they don't haveall that suffering to go with it
.
It's another funny story One ofmy earlier patients I had here,
one of my neighbors.
I did his surgery the weekbefore the 4th of July, so end
of June 2023.
So he was in the first 15patients probably, and so he had
(29:17):
a surgery four days before the4th of July.
He went to a 4th of July partydown the street and he walked in
and left his walker at thefront door and he was walking
around mingling with everybody.
And there was another doctor atthe party who was an
anesthesiologist who couldn'tbelieve it that he had just had
knee replacement surgery.
And the guy actually told himyou don't know what surgery you
(29:39):
had because you couldn't havehad a knee replacement.
You wouldn't be walking around,you'd be hurting a lot more.
So I thought that was kind offunny that somebody else who
didn't know what the patient hadtold him oh, you couldn't have
had a knee replacement.
But we've heard that over andover again.
Janet Walker (29:55):
Well, you've definitely got a lot of happy
patients on that Facebook groupand, just for comparison, I
joined another knee surgeryFacebook group that was just
like a traditional kneereplacement Facebook group and
what a difference in terms ofhow people feel about the
procedure post-operatively andwhat they're experiencing.
(30:19):
And, like you said, people.
Well, there was someone thatwas climbing a mountain seven
weeks past surgery one of yourpatients in Arizona and people
on the other group are stillusing a walker at seven weeks
post-op.
So yeah, it seems like it's ahuge difference in how patients
(30:44):
are recovering.
Let's talk a little bit aboutpost-op recovery and compare
traditional surgery to JiffyKnee.
So hospital stay, inpatient oroutpatient.
Timothy Kavanaugh, MD (30:56):
Jiffy knee.
So hospital stay, inpatient oroutpatient.
Jiffy Knee is 85% outpatient,which is great, so you get to go
home.
You sleep in your own bed thenight of surgery.
There's a lot of disadvantagesto being in a hospital after an
elective joint replacement.
First and foremost there'sinfections in hospitals of
(31:16):
various types and you know, thelast thing anybody wants after a
clean hip or knee replacementis an infection.
That's a big deal avoiding bygoing home the same day.
And then you know just the PTrecovery we have now for this, I
believe, is just top notch andit's part of what contributes to
why these results are so goodby having that exercise bike at
(31:38):
home that the patients do theprogram on and it makes a big
difference in post-operativepain, post-operative swelling
and just the post-operativemobility.
Janet Walker (31:50):
Nice and some of these things we've touched upon,
but I'm going to ask a few ofthem again.
So, post-op pain medication,typically with Jiffy Knee, how
many days versus traditional,how many days?
Timothy Kavanaugh, MD (32:17):
stop Jiffy Knee patients.
Everybody gets a week's worthof oxycodone.
Most people don't use the wholeprescription and about 15% of
patients ask for a second one,whereas with traditional surgery
it's really common to still begiving narcotics to people six
to eight weeks out, sometimes 10weeks out, especially around
the time of PT.
Now the other medications weuse to help with post-op pain
(32:41):
Tylenol is a staple after theJiffy Knee, as is an
anti-inflammatory, whetherthat's a prescription strength
one or a lot of people end upusing ibuprofen or Advil, I
believe.
And then we do usepost-operative steroids to help
control swelling.
Janet Walker (32:56):
A need for assistive devices like walkers,
crutches or canes Jiffy Kneeversus traditional.
Timothy Kavanaugh, MD (33:05):
So everybody goes home from the
hospital or surgery center witha walker.
Some people use it for a day,some people use it for a couple
days or a week, some people useit for two weeks, some people
use it for a couple days or aweek, some people use it for two
weeks and then go to a cane,and there's plenty of people who
go through that progression andend up using nothing, you know,
three or four days out.
(33:25):
Some people are still on a canein two weeks.
It really depends on a couplethings.
One main thing is what is theshape of the leg prior to
surgery?
You know, if you havesignificant quad weakness it's
going to be harder to progress,obviously because the muscle has
to build back up, just likeanything else in life.
And then the individualswelling response after surgery.
(33:49):
You know, some people we stillsee, even with , get a pretty
significant swelling responseand that's more individualized
on how your body responds to thesurgery itself.
We do a couple of things toreally kind of help prevent
swelling afterwards and I thinkit's been effective.
But once in a while you stillsee somebody who's got some
pretty significant swelling andthat just slows down the
(34:09):
recovery a little bit Now withcomparing that to my experience
with traditional surgery.
You know people were minimum ona walker for two, three weeks.
Usually.
It was extremely rare to eversee somebody who would progress
(34:30):
that okay.
I was off my walker in a coupleof days and on a cane, you know
it just, we call them unicorncouple of days and on a cane.
You know it just, we call themunicorns because they were that
rare that you know we justdidn't see a lot and so we're
just seeing that progression.
And then the other point of datathat we look at a lot and
(34:51):
compare is that that three weekmark when the Jiffy Knee
patients now are going tooutpatient physical therapy.
So that's their first contactwith an objective outside
observer or physical therapistwho has a lot of experience with
rehabbing knees.
And we're just hearing thesereports from physical therapists
around the Valley that whenthese patients show up, you
know we're just amazed at whatkind of motion they have already
(35:14):
, how easy it is to work withthem because they don't have a
ton of pain, they don't have aton of swelling and they're just
way ahead of where atraditional three-week post-op
knee patient is.
You know they're not havingthat suffering still, like a lot
of them are, and that's all dueto not cutting into that tendon
.
I'm completely convinced ofthat.
Janet Walker (35:37):
How important is physical therapy to recovery?
Timothy Kavanaugh, MD (35:42):
So PT after knee replacement surgery
is still incredibly important,at least probably 30-40% of the
whole entire procedure.
You know, if you look at thewhole picture, 30, 40% of the
whole entire procedure.
You know, if you look at thewhole picture you know pretty
much everybody needs somestrengthening after one of these
because they come into thesurgery with muscle that isn't
(36:03):
quite up to strength, you know,because you have an arthritic
knee.
And you know the therapistsalso are the coaches.
After all this.
They're looking at eachindividual patient and thinking
about how we can maximize theresult and that's what helps
everybody get the best happyresults here, you know.
(36:26):
So therapy, as I mentioned nowwith this protocol using the
RomTech bike, is great becauseat home it's doing five sessions
a day for three weeks andthat's something we monitor in
the office.
And then we switch you over tooutpatient PT and pretty much
everybody has that.
There's probably about it'sless than 10% of the patients
(36:47):
who insurance doesn't cover theRomTech and they end up going
right to PT.
But that's still a greatalternative.
You alternative getting in witha PT right away and working
with them to get the range ofmotion and strengthening.
Janet Walker (37:01):
How would you say that Jiffy Knee figures into the
future of knee replacementsurgery?
Timothy Kavanaugh, MD (37:09):
It's a great question.
I think that, knowing what Iknow and seeing how reproducible
this procedure is, and thenwhat kind of results you get
from it, patient after patient,and let me say that I think you
know in medicine we treatpatients, we don't treat robots
(37:32):
or automobiles.
So you know it's individualsthat we're taking care of, right
, no matter what we're doing andwhat field of medicine.
So not everybody behaves thesame way with any given
procedure or intervention, anymedication.
You know so.
But what I think does for theentire population of knee
(37:55):
replacement patients is it takesthe bar and moves it way up for
their recovery.
And that's why when I tellpatients you know what's it
going to do for them, I tellthem it's going to improve.
You know your life, in a sensethat you know the recovery is
going to be significantly betterfor you.
The recovery is going to besignificantly better for you and
your pain is going to besignificantly less relative to
(38:17):
what I know for 21 years doingtraditional surgery.
So this is a huge leap forward.
I think, and I foresee inprobably five to seven years,
that this will be the dominantway to put in knee replacements.
It's here to stay.
It's going to keep growing.
(38:40):
You know surgeons are slow toadopt things.
As I mentioned earlier, it's abig deal to change surgical
approaches, but I think oncemore people learn about this and
see the results in patients andget inspired to actually start
doing it, they'll see that youknow quality, technical,
technical quality good surgeonscan do this reproducibly and get
great results.
This is going to expand and sowe're going to see this spread
(39:01):
around the country and someexciting news here in the Valley
.
You know we just um are goingto hire another surgeon in our
group, an experienced joint, hipand knee replacement surgeon,
to join us starting in January.
He's going to join our groupand he's going to be in an
(39:24):
office that we're going to haveout West in the Sun City area
just to have another providerhere who can give this procedure
to patients.
And I just you know things arebusy for me and it's great, but
I also, you know, look at it asfrom a patient perspective that
(39:47):
you know I don't think it's fairto wait forever for something
like this, even though it's verygood and I think it's worth
waiting for.
So in my mindset, I want tomake this available to more
patients, and so we're alwaysaround here going to look to
expand this and get more peopletaken care of with it.
So that's my philosophy andthat's how I want to look at it.
(40:10):
So that's why we're addinganother surgeon already.
You know, with me being 18months into this, knowing how
good it is and seeing intopatients, so we're going to keep
expanding this and offering itto more and more patients.
Janet Walker (40:21):
Oh, that is exciting news.
That is really exciting news.
Yeah, what about age range?
What's the youngest?
Timothy Kavanaugh, MD (40:31):
patient, so the age range is from 26 to
94.
Janet Walker (40:42):
Wow.
Timothy Kavanaugh, MD (40:43):
Yeah, so in my entire career the youngest
patient I ever have done a kneereplacement on was 25.
Jiffy needs 26.
And so those are patients whenyou get down into the twenties
and thirties, um, who need kneereplacements.
Those are patients who havesome congenital problem, uh,
post-traumatic problem.
(41:03):
You know they had a badfracture 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 comesinto play when you have the
younger side.
The oldest patient I've everdone knee replacements in is a
96 year old lady.
Um, that was when I was up inAlaska.
(41:25):
So the oldest Jiffy is 94.
Um, and you know this is a ladywho you know couldn't hike
anymore.
She used to hike every day upin Alaska and she got to a point
where her knees weren't lettingher do that.
So you know she was healthy andwe did knee replacements in her
.
You know one at a time.
And the interesting thing isthat you know age especially.
(41:49):
I found around here in Arizona.
You know there's so manyhealthy 90,.
I found around here in Arizona.
You know there's so manyhealthy 90, high eighties and 90
year olds, you know.
So age really isn't a limitingfactor, it's really your overall
health condition.
Janet Walker (42:11):
So it's available, that's.
That's really a great thing tohear that even people that are
in their eighties or ninetiesare able to get this procedure
and have some mobility andquality of life and relief from
pain, even in those later years.
Timothy Kavanaugh, MD (42:20):
It is a great feeling to be able to
offer to patients Yep.
Janet Walker (42:24):
Dr Kavanaugh, thank you so much for being with
us and educating us about totalknee replacement and especially
about the procedure.
Timothy Kavanaugh, MD (42:32):
Yeah, thank you.
Janet Walker (42:33):
It's such an important topic for so many
Americans and I hope I can talkto you again about this or
another orthopedic issue that somany people want to learn about
.
Certainly, listeners, you canschedule an appointment to see
Dr Kavanaugh and the other MDsat AZ Ortho in his Scottsdale,
arizona or new West Valleyoffice, or learn more about the
(42:57):
Jiffy Knee procedure online atazortho.
com or jiffyknee.
com.
That's J-I-F-F-Y-K-N-E-E.
com.
I'll have links to bothwebsites in the show notes on
the podcast website athealthyCellsPodcast.
com.
Stay tuned for more episodes inmy knee replacement series
(43:21):
featuring one of the country'sleading physical therapists in
knee replacement recovery.
Thanks so much for listening tothe Healthy Cells Healthy you
podcast with me, your host,Janet Walker.
You can find us on ApplePodcasts, google Podcasts iHeart
radio , Spotify or wherever youget your podcasts.
Subscribe and tell your friends.
(43:42):
We'll help you find solutionsand together we'll build a
healthier you.
Our knees are there to support us in every
step we take.
We go through life not eventhinking about them, until one
day, a pop, a snap, an ouch ormaybe it's more gradual an
occasional ache that gets worseand worse and turns into a
constant pain.
What was once something younever thought about about
(00:25):
suddenly becomes all you canthink about.
Today we're talking to one ofthe country's top experts in
knees and we'll learn about theJiffy Knee, a revolutionary new
approach to knee replacementsurgery that preserves soft
tissue, minimizes trauma to themuscle and tendons and has been
providing patients withsignificantly faster recovery
(00:46):
and less post-surgery pain.
It's giving knee replacementpatients an amazing recovery
story.
If you suffer from knee pain orlove someone that does, this is
an episode you don't want tomiss.
It's a new season of HealthyCells Healthy you.
I'm your host, Janet Walker.
I've been working in thehealthcare community for over 30
(01:08):
years and for 20 of those yearsI've also worked as a writer
and producer for the WindsorBroadcasting award-winning
national PBS, health informationTV shows, American Health
Journal and Innovations inMedicine.
We've interviewed thousands ofdoctors, scientists and
researchers on every topicrelated to health, medicine and
(01:28):
medical technology.
You can watch current episodesof Innovations in Medicine on
your local PBS channel or youcan stream our programs on the
American Health Journal channel,the Better Health channel and
TV Healthy Kids.
Starting this season, I'll alsobe a new host for Windsor's
award-winning podcast, betterWellness.
Today's guest is renownedorthopedic surgeon Timothy
(01:51):
Kavanaugh of AZ Ortho inScottsdale, Arizona.
Dr Cavanaugh is board certifiedand fellowship trained,
specializing in the newestsurgical and non-surgical
treatments for knee, shoulderand hip pain.
Dr Kavanaugh has performed over8,000 joint replacement
surgeries and over 1,000 JiffyKnee procedures.
Welcome to the show, DrKavanaugh.
Timothy Kavanaugh, MD (02:14):
Hi Janet, Thanks for having me.
Janet Walker (02:16):
So, according to the American Academy of
Orthopedic Surgeons, 700,000total knee replacements are
performed in the United Statesevery year, which surprised me.
That's a lot, so that meansthere's a lot of patients trying
to get their mobility andquality of life back.
Let's start with some basics.
Knee pain is a common complaintof people of all ages.
(02:39):
What are some of the conditionsthat cause knee pain that no
longer responds to conservativetreatments?
Timothy Kavanaugh, MD (02:46):
So there's a variety of conditions
that can lead to knee pain thatend up causing people to see an
orthopedic surgeon.
Most of those are various formsof arthritis, which
osteoarthritis is the main typeof arthritis out there.
(03:06):
That is the common wear andtear arthritis that we hear
about.
It is something that runs infamilies.
I tell patients that probablyat least 50% of arthritis
diagnoses run in families, sothere's a genetic component to
it for sure, and then there'sdefinitely a component that
(03:28):
causes it to be accelerated fromprevious surgical conditions or
knee injuries.
Other conditions are rheumatoidarthritis, 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.
(03:48):
It gets fixed and heals, butthere's always damage to the
cartilage when that happens andthat can lead to arthritis down
the line.
Those are probably the mainones that I see in the office.
Janet Walker (04:02):
Now, you've performed thousands of total
knee replacements and it's notminor surgery.
When is the right time for apatient to consider a surgical
repair like total kneereplacement?
Timothy Kavanaugh, MD (04:15):
That's a great question.
I think that it is an answerthat varies from patient to
patient.
I think you really have to takeinto account how much the knee
is bothering you, how much it isslowing you down and not
allowing you to live your lifewhether it's just with everyday
activities or recreationalactivities or both and how much
(04:39):
it's affecting your overallquality of life.
And I think when you thinkabout those aspects of it,
that's when you can be confidentthat you're making the right
decision to go ahead with kneereplacement.
After all, conservative meanshave been exhausted for
treatment.
Janet Walker (04:56):
Let's talk about the procedure itself Now, before
we discuss Jiffy Knee.
What happens during traditionaltotal knee replacement surgery?
Timothy Kavanaugh, MD (05:05):
So I would like to take that a step
further back and just talk aboutwhat happens during knee
replacement, because a lot ofpeople have different ideas of
what we actually do in there.
So to start out with what abasic knee replacement does is
it removes the worn outcartilage and basically the ends
(05:27):
of the bone and replaces itwith metal and plastic.
So when you look at the knee, alot of people think we make a
cut, you know, five or sixinches above the knee, five or
six inches below the knee, andremove everything in between.
And that's not the case.
We're just taking off the endsof the bone, so probably at most
like a quarter inch bone, andwe're using all the rest of that
(05:49):
bone to put our implants on.
So that's one misconception Ijust want to start out with.
It almost is a misnomer to callit a replacement.
It'd be better to call it aresurfacing, in a way to better
understand it for everybody, ina way to better understand it
for everybody.
So traditional knee replacementversus jiffy knee.
What happens in a traditional?
(06:14):
And we all know patients whohave that straight anterior
incision right down the front ofthe knee.
You see it every day and youprobably have a lot of family or
friends that have had it doneand I used to do it.
You know I did over 6,000 ofthem that way in my 21 years of
doing them.
And under the skin you gothrough and cut the quad tendon
or the quad muscle or somecombination of both in order to
(06:37):
get into the joint and you splitit apart, you do the knee
replacement and then you sew itback up on the way out and,
knowing what I know now, havingdone that for 21 years and I
don't do that anymore thatapproach is what I'm convinced
(07:00):
causes most of the pain anddisability after surgery.
Because we don't see that withthe jiffy knee.
Most people, if you talk tothem after traditional knee
replacement surgery, would tellyou that it was a pretty rough
ride for the first three to sixmonths, sometimes, especially
during therapy sessions.
And what the procedure nowworks on is that first three to
six months where we're notseeing the suffering and we're
(07:23):
seeing patients do a lot better,a lot quicker and get back to
life quicker.
Janet Walker (07:28):
So then, are there different types of implants,
and how do you select the rightimplant for each patient?
Timothy Kavanaugh, MD (07:35):
There are .
There are multiple differenttypes of implants.
The basics of any knee implantare metal and plastic, which is
high-density polyethylene.
So the metal components arewhat is fixed to the bone on the
end of the femur and top of thetibia.
The plastic layer goes inbetween those two and is the
(07:56):
bearing surface.
And in most knee replacementsthere's a plastic button that
goes on the underside of thekneecap that replaces the
arthritis there, button thatgoes on the underside of the
kneecap that replaces thearthritis there.
The metal most commonly istitanium in the tibial component
and an alloy of cobalt, chromeand nickel in the femoral
(08:18):
component.
There are different variationsof knee replacements that take
into account different functionsof the cruciate ligament.
There's also different types ofplastics that account for
different geometries andstabilities of the knee and
there's also knee replacements,for example, for people who have
metal allergies and we canavoid using nickel, which is the
common metal that people areusually allergic to.
(08:40):
So we have a nickel-freeimplant that I use in some cases
allergic to.
So we have a nickel-freeimplant that I use in some cases
.
Janet Walker (08:45):
So it really is a custom procedure.
No two patients are exactlyalike.
Timothy Kavanaugh, MD (08:57):
That is true, and no two knees in two
patients are usually alikeeither.
You know, there's subtlevariations in the bone quality
and the alignment and the softtissue around the knee, the
ligaments and tendons that canbe tight in one knee and not
tight in another knee, forexample.
So it really is kind of aunique procedure for each
individual patient.
Janet Walker (09:14):
And then I've seen a lot of ads for robotic knee
surgery.
Do you use robotics in yourpractice, and is that necessary
for a successful procedure?
Timothy Kavanaugh, MD (09:26):
So what that means is there are robots
that are made by some of theorthopedic companies to put
their implants in, and therobots help sense different
alignments, different ligamenttensions, and then they have a
robot arm that comes in andhelps the surgeon make the cuts.
I don't use robotics.
(09:48):
I've tried them all and I neverreally was satisfied with any
particular system.
I use something called computernavigation, which is a device
that we affix to the end of thefemur and top of the tibia
during surgery.
That measures the patient'salignment and helps me line up
the implants that way.
Janet Walker (10:08):
Now, before you were trained in the Jiffy Knee
technique, how many kneereplacement procedures had you
performed?
Timothy Kavanaugh, MD (10:16):
I've done over 6,000 primary total knee
replacements.
Janet Walker (10:21):
That's a lot.
Timothy Kavanaugh, MD (10:22):
The traditional way.
Yeah, that is a few.
And overall pretty successfulthen Knee replacement is one of
the most successful proceduresin all medicine yes.
So if you look at theliterature, it has right around
85% outcomes of good andexcellent results.
Janet Walker (10:41):
So then now let's get to the exciting stuff.
Let's talk a little bit aboutJiffy Knee, invented by Virginia
orthopedic surgeon Manish Patel, and you were the first doctor
outside of his own practicetrained in the technique,
certified in the technique.
Is that correct?
Timothy Kavanaugh, MD (11:00):
That is correct.
Janet Walker (11:01):
So how did you learn about Jiffy Knee?
What drew you to it, given thatyou've done so many successful
traditional procedures?
Timothy Kavanaugh, MD (11:10):
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 onLinkedIn for a while now and he
actually reached out to me onLinkedIn about it and I didn't
(11:33):
know it at the time.
But we have a mutual friend andour friend was one who told him
when he decided he was going tostart teaching this procedure.
Our friend told him hey, youshould probably call Kavanaugh
and see if he's interested,because I've always kind of been
interested in this kind ofstuff throughout my career or
something that would benefitpatient recovery.
So he did.
(11:54):
He reached out to me and thefirst time he reached out I kind
of ignored it.
I thought it was kind of agoofy name and didn't think it
was something that you knowwould have any significant
benefit and you know.
So I kind of ignored it and, tohis credit, about a week or two
later he reached out to meagain.
He said, hey, do me a favor,just look at the patient videos
(12:17):
on my YouTube channel and thencall me.
And I thought, well, that'spretty confident of him.
So I got my interest and I wentand looked at the videos.
I couldn't believe what I saw.
These patients are 24, 48 hoursout from surgery and they're
going up and down stairs,they're walking without any
(12:37):
assistive devices and they lookvery comfortable.
They're talking about not usingany significant narcotics and I
had never seen anything likethis in my career.
So I decided to go out andvisit him and we flew out there
and on the day I went to visithim we did eight of these in the
OR and I got to see what he wasdoing, how this technique
(13:00):
really works in the OR withretractor placement etc.
Really works in the OR withretractor 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 reproduceit.
Um, but what really sold me was, uh, I talked to the patients
that day in the surgery centerand there were two in particular
(13:22):
that were coming back for theirsecond knee and they're both
about six weeks out from theirfirst knee, which is also
unheard of for the most partwith traditional surgery, quick
and one, yeah, very quick.
And I'll never forget this oneolder lady who told me when I
(13:42):
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, orshe told me.
She's like, yeah, right away.
When I went to PT, I wassitting in a room with a bunch
of other people who had atraditional surgery and they
were all hurting and I was ableto do my PT and I wasn't hurting
(14:05):
.
And so she went up to each oneof them and told them that you
know, the reason you're hurtingis because you had it the old
way and I had the new way.
And I thought to myself I'mlike this lady here is telling
me what I need to do, so Idecided, on a plane ride on the
way home, I'm like I gotta dothis, it's too good.
Um, and so we signed up and, uh, started doing a June 1st of
(14:30):
2023 and the rest is history, soto speak.
I mean we're.
We're just over a thousand ofthem to date.
Wow and uh, it's been prettyincredible.
Janet Walker (14:42):
I gotta say and so you're doing only Jiffy knee
procedures, now for knee.
Timothy Kavanaugh, MD (14:47):
Since June 1st of last year I have
done only the Jiffy kneetechnique on all of all of my
knee patients.
Yeah, it's too valuable to tonot do on somebody.
I feel, and everybody that I'veseen has benefited from it.
Janet Walker (15:04):
Explain again exactly how Jiffy Knee differs
from traditional kneereplacement, and is it the same
muscle sparing or minimallyinvasive procedure that you see
a lot of ads for?
Timothy Kavanaugh, MD (15:19):
Good question.
So the Jiffy Knee theincision's on the inside part of
the knee, not straight in thefront like traditional surgery,
and I think that's where a hugeadvantage of it is not having
that incision right on the front, because that hinders people's
recovery when we're trying tobend the knee.
If you think about it, thatincision right on the front of
(15:41):
the knee as you're trying tobend it is under tension which
hurts.
It's actually stretching thewound and when you come in on
the inside and bend the kneeit's actually relaxing.
So that plays a role in it too.
And when you come in from theside, you're able to go
completely under the muscle andtendon with nothing being cut
and it slides out of the way todo the surgery, slides back in
(16:04):
place when we're done, with nocompromise on my part of
anything.
I need to see or angles, I needto measure or anything like that
to put in the knee correctly,and then you have the benefit of
having the entire muscle andtendon not cut.
So the quad, sparing, musclesparing, minimally invasive all
those terms are very nondescriptand you don't know for sure
(16:26):
what people do in there.
I've explored all of them in mycareer and nothing is like this
, the jiffy knee.
But what most of those entailare some variation of going in
from the front and coming aroundunder the skin, undermining all
that, and then either minimallycutting into the muscle or
(16:47):
going under it in a sub-vastusapproach from the side, the
difference being that the jiffyknee doesn't undermine any of
the skin, so you don't havethose big skin flaps that cause
pain and swelling and bleedingunderneath them too.
So I think that's a majordifference with the techniques.
Janet Walker (17:06):
So it is different For a patient to know for
certain that they're getting theJiffy Knee procedure.
They need to what.
Go to the Jiffy Knee websiteand make sure that their surgeon
is on the list of certifiedJiffy Knee providers.
Is that how someone would knowfor certain that they're getting
(17:28):
?
Timothy Kavanaugh, MD (17:28):
the Jiffy knee.
Yeah, that's correct.
Yes, that's the only way forsure to know that you're getting
a Jiffy knee.
Janet Walker (17:37):
And then can any patient who's eligible for
traditional knee surgery havethe Jiffy Knee Procedure, or are
there some patients thatwouldn't be candidates for it?
Timothy Kavanaugh, MD (17:48):
So in my practice anyone who I think is a
candidate for a kneereplacement is a candidate for a
Jiffy Knee Replacement.
So I'm doing it in, as Imentioned, since June 1st last
year I'm doing it in all mypatients.
I've even expanded it into myrevision surgeries.
So my redo patients Part of mypractice because of what I do
(18:12):
involves revision surgeryprobably about 20% of it and I
felt early on that I could dothe revisions through the in
patients who have had previoustraditional surgery with that
anterior incision.
So I started doing it and Ifound that I can successfully do
it through the incision andthese patients benefit from not
(18:36):
having that tendon cut, justlike the primary patients do.
Janet Walker (18:41):
So there's not a patient that's not eligible for
, but they would be eligible fortraditional surgery.
Any patient who's eligible fortraditional knee replacement
surgery would still be a goodcandidate for .
Timothy Kavanaugh, MD (18:58):
Yeah, that's correct.
Basically anybody who qualifiesfor a knee replacement is a
Jiffy Knee candidate.
Janet Walker (19:06):
in my practice, With regard to pain, mobility
and recovery after surgery.
How does Jiffy Knee compare totraditional knee replacement
surgery?
Timothy Kavanaugh, MD (19:19):
So what we see in the Jiffy Knee
patients, by not cutting intothe muscle and tendon, is
significantly less pain rightoff the bat, and I think the
best example of that is ournarcotic use after these
procedures.
So traditionally, for 21 yearsI'm used to giving narcotics to
(19:40):
total knee replacement patients,sometimes up to eight, 10 weeks
afterwards, and so what wenoticed in the Jiffy knee
patients right away is everybodygets a one week prescription of
oxycodone to go home with, andwe're seeing probably 15 max 20%
of the patients asking for asecond narcotic prescription, so
(20:03):
significantly less narcoticsbeing prescribed, which is great
in so many ways.
Janet Walker (20:07):
Oh, that's great.
Timothy Kavanaugh, MD (20:08):
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'redoing something that, just by
doing a procedure, causes lesspain and less of a need for
narcotics.
So we're seeing this pain bemanaged quite readily with a
combination of Tylenol and ananti-inflammatory medication,
(20:30):
along with some post-op steroidsearly on and then an
intermittent narcotic mixed in.
What we're seeing with regardsto rehab afterwards is the
ability to participate in anactive recovery really quick.
You know we start with usingthe Romtech exercise bike that
was designed specifically forknee rehab.
(20:51):
We use that in almost all ofour patients.
It gets delivered to the house.
That's a three-week physicaltherapy program that you do five
times a day on the bike andthen we go to traditional
outpatient PT at three weeks aday on the bike and then we go
to traditional outpatient PT atthree weeks.
But we're seeing patients gofor walks in a neighborhood with
a cane or with nothing.
You know that first weekendafter surgery Driving a car is
(21:17):
usually right around seven to 10days.
I have people playing golf likeliterally going out and playing
18 holes of golf three weeksout.
That's happened numerous timesRiding a bike outside, you know,
a couple weeks after surgery.
Janet Walker (21:33):
Wow, pick a ball four or five weeks out.
Timothy Kavanaugh, MD (21:35):
You know things that you never, ever saw
with traditional surgery.
Janet Walker (21:39):
Just knowing these things going into it must
really help alleviate the fearfactor that a lot of patients
have.
Just knowing that they're notgoing to have to be on narcotics
after surgery for weeks andweeks must make people feel a
lot better going into it.
Timothy Kavanaugh, MD (21:56):
I think it does confidence that what
they know whether it wassomething they experienced
themselves on one side anddecided I'm not going to have
the other side done, or they sawin 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 worthit.
(22:16):
They see these patients nowrecover with the jiffy knee and
they think to themselves, okay,I can do this.
And they're right.
You know, when people come inand talk to me about it and say,
okay, I think I can do thisprocedure, I tell them you can,
you know, with confidence.
Janet Walker (22:31):
That's great.
Timothy Kavanaugh, MD (22:32):
And it's a nice thing to be able to tell
the patients you know you're notgoing to see the suffering.
Janet Walker (22:36):
Nice.
So does insurance and Medicarecover Jiffy Knee, just like it
would cover traditional kneesurgery.
Timothy Kavanaugh, MD (22:45):
Yes, that's a very common question
that I get and as far as anyinsurance, including Medicare,
is concerned, it is a total kneereplacement, so there's no
extra charges for it.
There's nothing that will spillextra for the procedure itself,
so it is covered just like atraditional surgery.
Janet Walker (23:07):
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 thatthey can have a Jiffy Knee
procedure.
Would an insurance cover that?
Timothy Kavanaugh, MD (23:25):
So what we have seen and we're not only
seeing patients local here inArizona come in for this
procedure, but we're seeingout-of-state patients who have
different networks Blue Cross,blue Shield, New Mexico,
Colorado, for example and sowe're Blue Cross, blue Shield
providers and so it is coveredby those insurances.
(23:47):
We're, on pretty much everyplan, major insurance carrier,
so we're not seeing anysignificant problems with that.
Janet Walker (23:57):
So I first saw a social media ad for Jiffy Knee
about six months ago and thename looked a little goofy to me
too.
I assumed it was something kindof hokey, but then I clicked on
the website and I thought, oh,this is a promising, really
legitimate surgical procedureand lots of happy patient
(24:20):
testimonials.
So at that time, there wereabout a dozen surgeons trained
throughout the country, and you,of course, being one of the
first, and so when we firstconnected, you directed me to
the Facebook patient group whichhad just been formed.
I joined that group and therewere about 100 patients.
(24:41):
Now, just a few months later,about 100 patients.
Now, just a few months later,there's double the original
amount of surgeons that werethere when I first went on the
website, and that Facebook pagehas over 1100 members.
So why do you think thisprocedure is getting such
traction among doctors andpatients?
Timothy Kavanaugh, MD (25:03):
That's a great question.
I think that, first of all,with the surgeons, it's gaining
traction because it's people whoare interested in looking for a
better way to do things, andthat's what this comes down to
for us.
You know, changing surgicalapproaches for a surgeon from
what you've been taught, I tellpatients the closest thing I
(25:24):
could give an example to is likechanging religions.
You know, it's something youkind of grew up with surgically.
You learned on it.
You do it that way because thepeople who are your mentors
taught it to you that way and itworks right.
And even though kneereplacement is a rough ride for
a lot of people for a while,there's still really good
(25:47):
long-term results and that's whyit's always the mentality has
been well, I'm going to do itthis way because I know how to
do it this way and it works andit gets good results long-term
when you have an open mind andyou can assess things and, as I
mentioned earlier, andthroughout my career, I've
always kind of kept an open mindto look for things that are
(26:08):
better, and so many things havecome 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 yearsfor 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 thisTechnically, it's not going to
(26:29):
put the patient at risk, or myskills 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 patientresults.
Like I said, I don't get anyextra money for doing this.
This is just me putting thisimplant in differently, and then
(26:55):
we're seeing these incrediblepatient results.
So now fast forward to thepatient side of this, and the
best part about this is it.
This is patients telling otherpatients or you know, it's funny
.
At first, when I started doingthis, this spread, you know.
Okay, people would come in theoffice and I would tell them
(27:17):
okay, I have this new techniqueI'm going to do that's going to
give you a quicker recovery,less pain and less swelling.
And so I had to talk themthrough the entire procedure why
it's different and why it's nota risky thing.
You know, we can safely do thisfor them.
And then we started seeing okay, well, now I heard about Ms
(27:38):
Smith, who had one done, youknow, or Ms Jones, they're my
neighbor, okay, and I want whatshe had, okay.
So that started happening inthe first couple of months.
And then, and there's theFacebook ads and the Facebook
talks.
You mentioned that I do.
I do a seminar about every sixto eight weeks on Facebook which
is a live Q&A, and those havegotten more and more popular and
(28:00):
it's a great way to connectwith patients and answer
questions and I think thepatients really appreciate that.
But now we're starting to see,like one of the funny ones that
I it's like that six degrees ofseparation thing.
You know, this was about sixweeks ago.
(28:31):
I saw a patient who said, yeah,degrees, five degrees away from
this patient was sitting infront of me and she was like oh
yeah.
So I called that guy and hetold me that you know, this is
the greatest thing and I need toget one of these.
And you know it's nice that thepatients are out there with
real life experiences in it,knowing that they're getting a
full knee replacement, which iswhat solves the problem of the
(28:53):
arthritis, and they don't haveall that suffering to go with it
.
It's another funny story One ofmy earlier patients I had here,
one of my neighbors.
I did his surgery the weekbefore the 4th of July, so end
of June 2023.
So he was in the first 15patients probably, and so he had
(29:17):
a surgery four days before the4th of July.
He went to a 4th of July partydown the street and he walked in
and left his walker at thefront door and he was walking
around mingling with everybody.
And there was another doctor atthe party who was an
anesthesiologist who couldn'tbelieve it that he had just had
knee replacement surgery.
And the guy actually told himyou don't know what surgery you
(29:39):
had because you couldn't havehad a knee replacement.
You wouldn't be walking around,you'd be hurting a lot more.
So I thought that was kind offunny that somebody else who
didn't know what the patient hadtold him oh, you couldn't have
had a knee replacement.
But we've heard that over andover again.
Janet Walker (29:55):
Well, you've definitely got a lot of happy
patients on that Facebook groupand, just for comparison, I
joined another knee surgeryFacebook group that was just
like a traditional kneereplacement Facebook group and
what a difference in terms ofhow people feel about the
procedure post-operatively andwhat they're experiencing.
(30:19):
And, like you said, people.
Well, there was someone thatwas climbing a mountain seven
weeks past surgery one of yourpatients in Arizona and people
on the other group are stillusing a walker at seven weeks
post-op.
So yeah, it seems like it's ahuge difference in how patients
(30:44):
are recovering.
Let's talk a little bit aboutpost-op recovery and compare
traditional surgery to JiffyKnee.
So hospital stay, inpatient oroutpatient.
Timothy Kavanaugh, MD (30:56):
Jiffy knee.
So hospital stay, inpatient oroutpatient.
Jiffy Knee is 85% outpatient,which is great, so you get to go
home.
You sleep in your own bed thenight of surgery.
There's a lot of disadvantagesto being in a hospital after an
elective joint replacement.
First and foremost there'sinfections in hospitals of
(31:16):
various types and you know, thelast thing anybody wants after a
clean hip or knee replacementis an infection.
That's a big deal avoiding bygoing home the same day.
And then you know just the PTrecovery we have now for this, I
believe, is just top notch andit's part of what contributes to
why these results are so goodby having that exercise bike at
(31:38):
home that the patients do theprogram on and it makes a big
difference in post-operativepain, post-operative swelling
and just the post-operativemobility.
Janet Walker (31:50):
Nice and some of these things we've touched upon,
but I'm going to ask a few ofthem again.
So, post-op pain medication,typically with Jiffy Knee, how
many days versus traditional,how many days?
Timothy Kavanaugh, MD (32:17):
stop Jiffy Knee patients.
Everybody gets a week's worthof oxycodone.
Most people don't use the wholeprescription and about 15% of
patients ask for a second one,whereas with traditional surgery
it's really common to still begiving narcotics to people six
to eight weeks out, sometimes 10weeks out, especially around
the time of PT.
Now the other medications weuse to help with post-op pain
(32:41):
Tylenol is a staple after theJiffy Knee, as is an
anti-inflammatory, whetherthat's a prescription strength
one or a lot of people end upusing ibuprofen or Advil, I
believe.
And then we do usepost-operative steroids to help
control swelling.
Janet Walker (32:56):
A need for assistive devices like walkers,
crutches or canes Jiffy Kneeversus traditional.
Timothy Kavanaugh, MD (33:05):
So everybody goes home from the
hospital or surgery center witha walker.
Some people use it for a day,some people use it for a couple
days or a week, some people useit for two weeks, some people
use it for a couple days or aweek, some people use it for two
weeks and then go to a cane,and there's plenty of people who
go through that progression andend up using nothing, you know,
three or four days out.
(33:25):
Some people are still on a canein two weeks.
It really depends on a couplethings.
One main thing is what is theshape of the leg prior to
surgery?
You know, if you havesignificant quad weakness it's
going to be harder to progress,obviously because the muscle has
to build back up, just likeanything else in life.
And then the individualswelling response after surgery.
(33:49):
You know, some people we stillsee, even with , get a pretty
significant swelling responseand that's more individualized
on how your body responds to thesurgery itself.
We do a couple of things toreally kind of help prevent
swelling afterwards and I thinkit's been effective.
But once in a while you stillsee somebody who's got some
pretty significant swelling andthat just slows down the
(34:09):
recovery a little bit Now withcomparing that to my experience
with traditional surgery.
You know people were minimum ona walker for two, three weeks.
Usually.
It was extremely rare to eversee somebody who would progress
(34:30):
that okay.
I was off my walker in a coupleof days and on a cane, you know
it just, we call them unicorncouple of days and on a cane.
You know it just, we call themunicorns because they were that
rare that you know we justdidn't see a lot and so we're
just seeing that progression.
And then the other point of datathat we look at a lot and
(34:51):
compare is that that three weekmark when the Jiffy Knee
patients now are going tooutpatient physical therapy.
So that's their first contactwith an objective outside
observer or physical therapistwho has a lot of experience with
rehabbing knees.
And we're just hearing thesereports from physical therapists
around the Valley that whenthese patients show up, you
know we're just amazed at whatkind of motion they have already
(35:14):
, how easy it is to work withthem because they don't have a
ton of pain, they don't have aton of swelling and they're just
way ahead of where atraditional three-week post-op
knee patient is.
You know they're not havingthat suffering still, like a lot
of them are, and that's all dueto not cutting into that tendon
.
I'm completely convinced ofthat.
Janet Walker (35:37):
How important is physical therapy to recovery?
Timothy Kavanaugh, MD (35:42):
So PT after knee replacement surgery
is still incredibly important,at least probably 30-40% of the
whole entire procedure.
You know, if you look at thewhole picture, 30, 40% of the
whole entire procedure.
You know, if you look at thewhole picture you know pretty
much everybody needs somestrengthening after one of these
because they come into thesurgery with muscle that isn't
(36:03):
quite up to strength, you know,because you have an arthritic
knee.
And you know the therapistsalso are the coaches.
After all this.
They're looking at eachindividual patient and thinking
about how we can maximize theresult and that's what helps
everybody get the best happyresults here, you know.
(36:26):
So therapy, as I mentioned nowwith this protocol using the
RomTech bike, is great becauseat home it's doing five sessions
a day for three weeks andthat's something we monitor in
the office.
And then we switch you over tooutpatient PT and pretty much
everybody has that.
There's probably about it'sless than 10% of the patients
(36:47):
who insurance doesn't cover theRomTech and they end up going
right to PT.
But that's still a greatalternative.
You alternative getting in witha PT right away and working
with them to get the range ofmotion and strengthening.
Janet Walker (37:01):
How would you say that Jiffy Knee figures into the
future of knee replacementsurgery?
Timothy Kavanaugh, MD (37:09):
It's a great question.
I think that, knowing what Iknow and seeing how reproducible
this procedure is, and thenwhat kind of results you get
from it, patient after patient,and let me say that I think you
know in medicine we treatpatients, we don't treat robots
(37:32):
or automobiles.
So you know it's individualsthat we're taking care of, right
, no matter what we're doing andwhat field of medicine.
So not everybody behaves thesame way with any given
procedure or intervention, anymedication.
You know so.
But what I think does for theentire population of knee
(37:55):
replacement patients is it takesthe bar and moves it way up for
their recovery.
And that's why when I tellpatients you know what's it
going to do for them, I tellthem it's going to improve.
You know your life, in a sensethat you know the recovery is
going to be significantly betterfor you.
The recovery is going to besignificantly better for you and
your pain is going to besignificantly less relative to
(38:17):
what I know for 21 years doingtraditional surgery.
So this is a huge leap forward.
I think, and I foresee inprobably five to seven years,
that this will be the dominantway to put in knee replacements.
It's here to stay.
It's going to keep growing.
(38:40):
You know surgeons are slow toadopt things.
As I mentioned earlier, it's abig deal to change surgical
approaches, but I think oncemore people learn about this and
see the results in patients andget inspired to actually start
doing it, they'll see that youknow quality, technical,
technical quality good surgeonscan do this reproducibly and get
great results.
This is going to expand and sowe're going to see this spread
(39:01):
around the country and someexciting news here in the Valley
.
You know we just um are goingto hire another surgeon in our
group, an experienced joint, hipand knee replacement surgeon,
to join us starting in January.
He's going to join our groupand he's going to be in an
(39:24):
office that we're going to haveout West in the Sun City area
just to have another providerhere who can give this procedure
to patients.
And I just you know things arebusy for me and it's great, but
I also, you know, look at it asfrom a patient perspective that
(39:47):
you know I don't think it's fairto wait forever for something
like this, even though it's verygood and I think it's worth
waiting for.
So in my mindset, I want tomake this available to more
patients, and so we're alwaysaround here going to look to
expand this and get more peopletaken care of with it.
So that's my philosophy andthat's how I want to look at it.
(40:10):
So that's why we're addinganother surgeon already.
You know, with me being 18months into this, knowing how
good it is and seeing intopatients, so we're going to keep
expanding this and offering itto more and more patients.
Janet Walker (40:21):
Oh, that is exciting news.
That is really exciting news.
Yeah, what about age range?
What's the youngest?
Timothy Kavanaugh, MD (40:31):
patient, so the age range is from 26 to
94.
Janet Walker (40:42):
Wow.
Timothy Kavanaugh, MD (40:43):
Yeah, so in my entire career the youngest
patient I ever have done a kneereplacement on was 25.
Jiffy needs 26.
And so those are patients whenyou get down into the twenties
and thirties, um, who need kneereplacements.
Those are patients who havesome congenital problem, uh,
post-traumatic problem.
(41:03):
You know they had a badfracture 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 comesinto play when you have the
younger side.
The oldest patient I've everdone knee replacements in is a
96 year old lady.
Um, that was when I was up inAlaska.
(41:25):
So the oldest Jiffy is 94.
Um, and you know this is a ladywho you know couldn't hike
anymore.
She used to hike every day upin Alaska and she got to a point
where her knees weren't lettingher do that.
So you know she was healthy andwe did knee replacements in her
.
You know one at a time.
And the interesting thing isthat you know age especially.
(41:49):
I found around here in Arizona.
You know there's so manyhealthy 90,.
I found around here in Arizona.
You know there's so manyhealthy 90, high eighties and 90
year olds, you know.
So age really isn't a limitingfactor, it's really your overall
health condition.
Janet Walker (42:11):
So it's available, that's.
That's really a great thing tohear that even people that are
in their eighties or ninetiesare able to get this procedure
and have some mobility andquality of life and relief from
pain, even in those later years.
Timothy Kavanaugh, MD (42:20):
It is a great feeling to be able to
offer to patients Yep.
Janet Walker (42:24):
Dr Kavanaugh, thank you so much for being with
us and educating us about totalknee replacement and especially
about the procedure.
Timothy Kavanaugh, MD (42:32):
Yeah, thank you.
Janet Walker (42:33):
It's such an important topic for so many
Americans and I hope I can talkto you again about this or
another orthopedic issue that somany people want to learn about
.
Certainly, listeners, you canschedule an appointment to see
Dr Kavanaugh and the other MDsat AZ Ortho in his Scottsdale,
arizona or new West Valleyoffice, or learn more about the
(42:57):
Jiffy Knee procedure online atazortho.
com or jiffyknee.
com.
That's J-I-F-F-Y-K-N-E-E.
com.
I'll have links to bothwebsites in the show notes on
the podcast website athealthyCellsPodcast.
com.
Stay tuned for more episodes inmy knee replacement series
(43:21):
featuring one of the country'sleading physical therapists in
knee replacement recovery.
Thanks so much for listening tothe Healthy Cells Healthy you
podcast with me, your host,Janet Walker.
You can find us on ApplePodcasts, google Podcasts iHeart
radio , Spotify or wherever youget your podcasts.
Subscribe and tell your friends.
(43:42):
We'll help you find solutionsand together we'll build a
healthier you.
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