Third Time’s A Charm

Patient returns home just hours after knee revision surgery.

Lara Sieder showing off the Tuna fish she caught

Lara Sieder

Though she grew up near the water and alongside a brother who engaged in the hobby regularly, it wasn’t until Lara Sieder was much older that she developed a passion for fishing. Now the 49-year-old commercial real estate broker is, well, hooked on the pastime.

“I absolutely love to fish,” Lara confirms. “I’ll fish for anything in the bay — redfish, snook, whatever. But it’s tarpon fishing that I love the most. I first got into it through work actually.

“My team at work did it all the time, and then we turned it into a client-type of event. We would take clients and other brokers out tarpon fishing, and it became a thing for us. We’ve been doing it for about 10 years now.”

Lara’s prize catch is a tarpon that weighed in at about 150 pounds. That whopper is one of about 15 tarpon she has caught. Each of those catches, though, has been made while she fought a whopper of a right knee issue that she’s struggled with since her teens.

“I don’t remember a triggering event that started it all, but I’ve always had this problem knee,” Lara explains. “I actually had my first arthroscopic surgery on it when I was in middle school. After that, I was getting it scoped about every two years.”

Around 2017, doctors decided Lara needed a partial replacement of the kneecap. The result of that surgery was not what she or even her doctor expected, however. The fallout in fact, was downright embarrassing.

For both parties.

“After the surgery, whenever I bent that knee or straightened it out, it would quack like a duck,” Lara informs. “I’m not kidding. It would actually quack like a duck. As you might expect, that can be pretty embarrassing when you’re in a conference or meeting with a client or something. You’re like, No, that’s not a duck; it’s just me.

“I put up with that for about 10 days or so, then went back to the doctor who did the surgery, and sure enough, he could hear it, too.”

Two weeks later, the knee was scoped again to learn why it was quacking. Somewhere in the midst of those two procedures, the knee became infected. This required another surgery to remove the partial implant and place a block, or spacer, of antibiotic cement in its place.

At the time, Lara was also fit with a peripherally inserted central catheter, or PICC line, to allow for the steady flow of intravenous antibiotic fluids into her system. After six weeks, the spacer and catheter were removed, and Lara had a complete knee replacement performed.

“But even after rehabbing that knee yet again, it still wasn’t right,” Lara laments. “I couldn’t quite bend it all the way, and at first I didn’t think anything of it because I had an artificial knee. I figured, Well, that’s probably what it’s supposed to feel like.

“But I kept having problems with it, and even after having another scope on it, nothing really changed. I learned to fight through the discomfort, again because I figured that was probably the way it was always going to be.”

Lara had all but resigned herself to the likelihood of a life with knee trouble. But her situation took an unexpected turn for the better a little more than a year later while she was showing office space to a physician opening a practice in South Tampa.

“The doctor noticed that I was limping and asked me about it,” Lara relates. “I told him that I’d had a knee replacement, and his response was, Oh, really? I honestly feel that it was like a miracle that, out of nowhere, he suddenly showed up in my life.”

Miracle Meeting

That doctor was Philip E. Clifford, MD, co-founder of the Outpatient Joint Replacement Center of America, where he specializes in a surgical protocol for the replacement of knees and hips that eliminates the need for long, postoperative hospital stays.

Not long after Dr. Clifford’s office opened, Lara called him and asked if he would examine her knee. During his initial examination, Dr. Clifford discovered not only the cause of her limp but another problem that required immediate attention.

“Her knee was infected again,” Dr. Clifford explains. “That was the biggest problem. The other issue was that the prosthetic that was put in the second time was not positioned correctly. That’s why she couldn’t bend her knee properly and was limping.”

Dr. Clifford attacked the infection first. Four months later, after the infection cleared, Dr. Clifford performed a revision surgery on Lara’s right knee, replacing the prosthetic with a new and improved one.

As he does during all replacement surgeries, Dr. Clifford applied the protocol that allows his knee and hip replacement patients to be fit with a new knee or hip joint and leave the surgical center the same day.

“One of the factors that makes this possible is the medicines we use,” Dr. Clifford explains. “One of those medicines is called Exparel®, a long-lasting, non-opioid, local anesthetic that can last for two to three days.

“For knee replacement surgery, we also perform what’s called an adductor canal block. When you do that along with a proper injection of Exparel, it allows the patient to get up and move around faster following surgery.

“Another feature that’s unique about our protocol is the surgical technique we use. For example, with our knee replacement surgery, we’re not assaulting the muscle; we’re incising the capsule of the joint. That, in and of itself, means less trauma.

“The same is true of our hip replacement surgery. That too is a minimally invasive, muscle-sparing replacement procedure that results in less muscle trauma and less bleeding. And the less muscle trauma and bleeding you have, the better.

“The hip procedure is also done through a small incision, about three to five inches long. This results in less trauma, which allows the patient to get up and start moving just hours after surgery with no limitations. In fact, we encourage our patients to do just that.”

New Year, New Knee

Further expediting the healing process is the type of artificial joint that Dr. Clifford implants. For knee replacement procedures, for example, the prosthetic is constructed to allow for faster recovery, one reason Dr. Clifford refers to it as “the best available.”

“With the vast majority of knee replacements, the plastic is fixed to the metal that goes into the tibia and is cemented in the tibia,” he says. “This implant is a rotating platform. That plastic part can swivel and rotate. That facilitates better and faster range of motion.

“For Lara, we used a much more evolved prosthesis. We had to because the bone loss from the previous surgeries was so substantial that we needed to put a rod up the femur and a rod down the tibia and use what are called revision components.”

Lara’s third knee replacement was performed on New Year’s Eve, a week after it was learned the joint was no longer infected. Lara walked away from her surgery a couple of hours after it began and says her knee is now “the best it’s been.”

“I didn’t want to take this problem into the new year, and thanks to Dr. Clifford I didn’t have to,” she says. “I will always have to work to build up the muscles around that knee to compensate for it, but the knee itself is no longer a problem.”

Relieved by the surgery’s outcome, Lara says the compassion and care shown by Dr. Clifford was “absolutely amazing.” It’s one of the reasons she so highly recommends the practice that alleviated her knee problems.

“I only have great things to say about Dr. Clifford,” she declares. “With most doctors, you’re a number, and that’s how I felt with the doctors who treated me before I found Dr. Clifford and Outpatient Joint Replacement Center of America.

“With Dr. Clifford, you’re not a number; you’re a person with a problem that he wants to solve. He was the only doctor I saw for this who really took the time to fully understand the problem and solve it correctly, and that’s why I think he is truly top-notch.”

© FHCN article by Roy Cummings. Photos courtesy of Lara Sieder. mkb
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