3D Knee Implant

What are the steps that are involved in creation of a customized 3-D knee replacement?

The first step in the process of creation of a customized 3-D knee replacement is evaluation by a surgeon to understand the patient’s knee joint and to evaluate if the patient is a candidate to get a customized knee replacement.

If the patient is indeed a candidate to receive a customized knee replacement, the surgeon orders a CT scan of the affected knee. The CT scan is then transferred to the company that manufactures the customized knee. The manufacturing company then starts to make the implant. The implant takes about 6 weeks to be manufactured and to be delivered to the hospital.

Which patients are not candidates to get customized 3-D knee replacement?

The patients with significant deformities and patients with ligamentous injuries are not candidates for customized 3-D knee replacement surgery. Additional contraindications for customized knee replacements include all the contraindications for a traditional knee replacement, as example active infection in the knee joint.

What are the problems that you had with the customized knee implants?

I have had the following issues with customized 3-D knee replacement –

  1. Some patients do not like to wait for long periods of time after their surgery is scheduled. As of 2018, the customized 3-D knee replacements take  about 6 weeks to manufacture and to deliver to the hospital. This is the major downside of using customized implants. The wait period is the major downside of using customized implants.
  2. The second issue that I have had occasionally is patients go to a radiology facility with the script which clearly mentions that the CT scan is for a customized knee implant. However, the technician just does a plain CT scan.

    This plain CT scan is not enough for making a computerized model and to generate the prototype of the knee and to construct the customized implant. The patient therefore has to go again to get the correct CT scan so that the customized knee implant can be manufactured.

  3. For preparation of the shin bone during a customized 3-D knee replacement, there is a jig which guides the drill into the deeper part of the shin bone. In my experience, this jig should be made stronger because on occasion (on preparation of the deep part of the shin bone) the jig sheared off prematurely.
  4. Some patients like to have their customized instruments that were used to replace their knees. These customized instruments need to be washed and processed before delivery to the patient.

    I have found that this is somewhat of a logistical issue coordinating washing of implants and handing it over to the patient. I have had these custom instruments processed and then these were delivered to my office and patients received these instruments in the first postoperative visit.

Can I go to any radiology facility for manufacturing the implant?

The patient has to go to very specific radiology centers which follow the protocol for making a customized 3-D knee replacement. The CT scan for the knee replacement surgery is very specific and not all radiology centers are able to do that.

When should I get my CT scan for getting a customized 3-D knee replacement?

I recommend getting a CT scan within 4 months of the scheduled surgery. The reason for this time frame is because if the deformity in the knee increases or if there are additional defects that arise in the knee after the initial CT scan is done, then the customized implant will not be as accurate as we want it to be.

If the patient is considering surgery after 6 months, it is best to get the CT scan at a later date. Most patients that I see really want the surgery at the earliest available date and therefore get the CT scan as soon as possible.

Can I get a custom 3-D knee replacement after failed partial knee replacement surgery?

The conversion of a failed partial knee replacement surgery to a full replacement surgery is called revision knee replacement. Custom knee replacements are not a good option for revision knee replacement surgery unless there are no revision knee systems in the market that can provide off the shelf options.

Why do I need a CT scan?

The customized 3-D knee replacement surgery is designed to match the natural knee joint. The CT scan provides accurate geometry for manufacturing this customized knee. The CT scan data is used to generate a computerized model of the custom knee by the custom knee manufacturing facility.

Additionally, the custom knee 3-D manufacturing facility also makes very specific instruments that are customized to the anatomy of the native knee for doing the customized knee replacement.

These instruments are made specifically for the patient and make the surgery less invasive. As an example drilling into the thigh bone and the shin bone is not needed because the instruments contour very well to the anatomy around the knee joint providing accurate alignment, rotation, offset for placement of the custom knee.

What is the earliest that the surgery can be scheduled after consultation with the doctor?

The earliest the surgery can be scheduled is 6 weeks from the time the CT scan is performed. The CT scan is performed immediately after seeing the surgeon. Six weeks is a reasonable time frame to schedule the surgery.

Additionally, it is important to ensure that the medical clearance for the patient is obtained prior to the surgery. I also get dental clearance prior to the surgery. It is important to note that the medical clearance as well as the blood investigations have to be done four weeks before the date of the surgery.

If additional tests, for example cardiac tests are mandated by the internist, the surgery may need to be postponed. All “I’s have to be dotted, T’s have to be crossed” before the patient is actually wheeled into the operating room.

How long does it take to get an appointment for a CT scan?

There are numerous radiology centers that do the CT scan and appointment for a CT scan is generally available within a couple of days.

How long does it take to do the CT scan?

The CT scan appointment generally takes less than an hour. The time varies according to the radiology facility, but generally a CT scan appointment takes up less than an hour.

How long does it take to do a customized knee replacement surgery?

A customized knee replacement surgery generally takes about one hour to one and half hour to perform. By the time the patient goes into the operating room and the nurse calls the relative to visit the patient, it is a lot longer than one and half hours. The additional time is because of the time required by the anesthesiologist to anesthetize the patient which may or may not include spinal anesthesia. There is also time that is needed to prep and drape the patient before the final surgery starts.

How does the customized instrumentation help in placement of the customized knee replacement?

The customized knee replacement is manufactured from the CT scan. This CT scan is also used for manufacturing the custom knee instrumentation. This instrumentation assists in implantation of the custom knee into the patient. The customized jigs conform very well to the anatomy around the knee joint.

How is customized instrumentation different from standard knee replacement instrumentation?

The traditional knee replacement uses an intramedullary guide for placement of jigs on to the thigh bone. This process involves drilling the hole into the thigh bone and placement of a rod into the bone to get an accurate alignment.

When a customized instrumentation is used, there is no need for placement of this intramedullary guide and there is no need to drill the bone, because the customized implants have already accounted for the alignment and geometry of the thigh bone and for the mechanical axis of the lower extremity. The surgery is therefore less invasive.

Similarly on the side of the shin bone (lower part of the knee joint), there are two ways to place the guide that is used for making the bone resections.

One way is to drill hole into the shin bone (“intramedullary” guide) and place a rod into it and attach a guide to it (similar to the thigh bone) or the surgeon may choose to use an “extramedullary” guide (which means that there is a rod on the outside of the shin bone) to accurately align the guide on the shin bone so that the knee implant on the shin side will be accurately aligned.

The custom instrumentation does not need an intramedullary guide. We use custom instrumentation for placement over the shin bone and the resection of the bone is made based on this less invasive guide.
In addition to using the customized instruments, I also use visual techniques to ensure that the cuts are accurate.

How do you think the customized 3-D knee replacement surgery can be improved even further?

There are several avenues in which the current technology for customized knees can be improved. First and foremost the manufacturing process needs to be shortened. The current six weeks period as of 2018 is very long in my opinion.

The patients should have the option of having knee replacement within 6 weeks of seeing the surgeon if all other requirements like medical clearances are met.

The CT scan does involve some radiation to the patient. With improved techniques, I feel we can significantly decrease the amount of radiation involved with CT scanning of the knee.

There are some steps in the process which I feel are not as accurate and could be improved. As an example, during placement of the jigs for alignment of the guides on the shin side of the bone, cartilage, if any, has to be manually scraped. I feel this could create inaccuracies if additional cartilage is scraped by the surgeon or if less cartilage is scraped by a surgeon.

The inaccuracy is very small. It is in millimeters, however, for patients who are tall, a small change in millimeter at the knee joint can vary the mechanical axis to a greater extent than patients who have shorter bones.

The cutting guides on the thigh bone could be consolidated into fewer cutting guides. As example, it is possible to create one cutting guide for all the cuts that are done on the thigh bone. The advantage of a single cutting guide for the femur is that the process will be faster.

Additionally, the inaccuracies will be decreased. For example, one cutting guide is placed, the cut is made and then the second cutting guide is placed on top of the first bone cut. I feel that if the first cutting guide is placed inaccurately, the first bone cut will be incorrect.

The second cutting guide placed on the first cut just adds additional errors to the subsequent bone cuts. The use of a single cutting guide will decrease these inaccuracies.

Additionally, it is difficult for the manufacturing process to account for the flexion deformity, which is due to the soft tissues. The computerized scan is very good at evaluation of the bony anatomy, however, the knee may be bent due to fluid in the knee joint or due to contractures which are outside the knee joint and the current protocol does not account for these contractures.

Is customized knee replacement cemented or uncemented?

The customized knee replacements are cemented into the shin bone and thigh bone. There is plastic in between the two metal parts. The underneath of the kneecap is also cemented into position.

Is there any part of the custom knee replacement which is not customized?

The underneath of the kneecap is replaced by plastic, which is off the shelf.  The underneath of the kneecap is not customized.

Does customized 3-D knee replacement obliterate the need for physical therapy after knee replacement surgery?

Physical therapy is mandatory after any knee replacement surgery including customized knee replacement. I do not change my immediate postoperative protocol for customized knee replacement. Without physical therapy, the range of motion of the knee can suffer.

Whatever range the patient has at 3 months after the surgery is what remains for life. I try to achieve as much range as range as possible during the surgery. This range has to be maintained postoperatively and physical therapy is a critical part of the postoperative protocol.

What should I expect immediately after coming out of the operating room after I have undergone a customized knee replacement?

After having customized knee replacement, if you have requested the surgeon may give you the mold from which your knee was manufactured. The patient’s implant was made from this mold. This mold is customized for you and is available for you to take home.

One of the issues that I have had is that there is some logistics involved in getting this mold and the custom instrumentation washed and processed and handing it over to the patients or relatives. Sometimes I have had the instruments washed, then delivered to my office and these instruments are then given to the patient in the postoperative visit to my office.

There are some patients who love having their own custom instruments. Doing a customized knee replacement allows them the options to have these taken home with them.

What is the difference between PSI or personalized instrumentation and custom knee replacement surgery?

“PSI” or “patient specific instrumentation” is technology of one company and “custom knee replacement” is of another. There is a significant difference between the two. PSI involves the instrumentation being specific for the patient. For PSI, the knee undergoes an MRI and the jigs (instruments used to replace the knee) are individualized or customized for the patient. The actual knee joint is “off the shelf”.

When you do a customized 3-D knee replacements do you get only one part that is customized for the patient?

No, the implant that caps the thigh bone and the shin bone is only one and is customized for the patient; however, the plastic between the two implants comes in numerous sizes. This allows intraoperative flexibility in resection of the bone as deemed best-fit by the surgeon.

How long do you anticipate the customized 3-D knee replacement to last?

Custom knee replacement is a relatively new procedure. We do not have long-term data on customized knee replacement surgery. The current data that is available for the past few years shows that the custom knee replacement surgery results are satisfactory. The results of the custom knee replacement are equivalent to traditional knee replacement surgery.

Is the custom 3-D knee replacement implant cleared by the FDA?

The routine 3D printed knee replacements manufactured as of 2018 are cleared by the FDA. On occasion if I am using a customized knee replacement for a significant defect in the knee joint or for treatment of knee joint after an infection or for revision, then I have had custom knee implants made by manufacturing companies which have not been cleared by the FDA.

However, I use it in my best judgement for these patients. These non-FDA approved implants are extremely far and few. The last one I did was several years before 2018. The current manufacturing company that routinely makes custom knee implants was not in existence at that time.

If a knee is necessitated by the patient which is custom made and which is not FDA approved, the patient will be counseled about that custom implant in advance.

This non-FDA approved custom implant will be used on patients who are not candidates to get routine off the shelf joint replacement implants and who are not candidates to get routine custom made knee implants. There is nothing in the market that can be used in these patients which is why I custom make these implants in the first place.

Custom 3-D knee implants are made up of what materials?

Custom knee implants are made of cobalt-chromium-molybdenum alloy and the plastic is medical grade plastic, which is ultra-high molecular weight polyethylene which is cross-linked and also can be vitamin D infused. This is also the standard material used in off-the-shelf implants.

Do Custom 3-D Knee Replacement cost more than a Regular Knee Replacement?

 Custom 3-D knee replacements do not cost more than off-the-shelf implants. There should be no additional cost to the patient.

Are there separate knees for men and women?

The customized knee replacements are customized for individual patients. The custom knee implants that I use are not available separately for women and men. There are no separate sizes for the implants that cap the thigh bone and the shin bone. It is just one customized implant for one patient.

Are you paid by a custom implant manufacturing company?

As of 2018, there is no implant company that pays me for anything! I do not get paid by any hospital nor does any pharmaceutical company pay me. I work only for my patients.

What are the different types of customized knee replacements?

Customized knee replacements are largely divided into the following:

  1. Total knee replacement which is posterior cruciate “substituting”.
  2. Posterior knee replacement which is posterior cruciate “retaining”.
  3. Bicondylar replacement with replacement of only one compartment of the shin bone called as the “iDuo” and then there is
  4. The unicompartmental customized knee replacement prosthesis.

What tests are needed before a customized knee replacement surgery?

A CT scan of the knee is needed to make a computerized model for the manufacturing company to make a customized knee implant. In addition the patient needs blood tests which are routine before any joint replacement surgery. The patient may need additional tests like cardiac stress tests that may be needed by the internist to clear the physician for surgery.

How long does it take to recover from a customized knee replacement surgery?

The time to recover from a customized knee replacement surgery is almost identical to traditional knee replacement surgery. The hope is that because the new prosthetic implant matches the anatomy of the native bone, the long-term satisfaction scores will be improved- this is the real advantage of customized knee replacements.

These questions have been personally answered by:

I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

You can see my full CV at my profile page.

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Based on 107 reviews
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18