My name is Adam Rosen. I am an orthopedic surgeon in Southern California. I did my residency in Philadelphia and fellowship in La Jolla. I have been in practice since 2005 performing total knee replacements. I am part of a teaching fellowship program and I try to share my thought process with our fellows. I am going to share my thought process here in an attempt to help you and potentially the patients that you care for.

This podcast series is really geared towards orthopedic residents or fellows or the community surgeon looking to pick up a pearl or two about total knee replacements. I do not believe that my way is the best way or the only way to care for patients with knee arthritis. I only offer my thoughts, opinions and treatment algorithms in the hopes that it will help you care for your patients. This is my opinion. You need to determine how to treat your own patients based on your experience, education and available scientific data.

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Here I discuss some of the things I look for when seeing patients in the office when I am deciding on what treatment options are appropriate. Weight bearing x-rays are important. Ask patients to describe their symptoms. Do not simply ask someone to describe their pain on a scale of one to ten. Find out how their knee has affected their quality of life. Lastly, find out what treatment options have been tried and be sure to offer conservative treatment options to the patient before undergoing surgery.

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Here I go into how I describe to a patient what a total knee replacement is by using a total knee model. I make it a habit to not only detail all of the potential risks of the surgery but I go into detail when certain risks are higher in an individual patient (such as infection risk in a diabetic). Explaining realistic expectations up front is extremely important in my opinion to create good patient satisfaction after total knee replacement surgery. I review with my patients normal expectations such as warmth, night pain, lateral numbness and clicking that can be seen in the early post-operative period.

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