Knee Replacement Procedure: Information for Out of Town Patients

Dr. Larry Likover, a leader in custom knee replacement, performs advanced knee replacement procedures for patients from across the country. If you are an out of town patient coming to Houston for an XP, Signature or Oxford knee replacement procedure, read the information provided below. If you have questions, please contact our office.

Signature Knee Replacement Procedure: Protocol for Out-of-Town Patients

Make Sure Office Staff Knows You are Coming from Out of Town

If you would like to come to Houston for a Signature custom knee replacement procedure, you need to be aware of several special circumstances. When you call or email for an appointment, make sure Dr. Likover’s staff knows you are coming from out of town. If that is the case, we will make you an appointment for the Signature MRI the same day you are seen.

This MRI cannot be done in your home town, and is only done on a very few machines in Houston. If we don’t reserve an MRI time on the day of your appointment, you may not be able to get this MRI while you are in town. You would then have to stay overnight or make a separate trip just for the MRI. Most patients return to Houston four weeks after being seen in my office for the Signature total knee replacement surgery.

Signature Knee Replacement Insurance Issues:

Medicare and all insurance companies cover Signature custom knee replacements, the special MRI and all additional costs associated with it. Doctor Likover is also happy to treat patients for whom Dr. Likover is not in their network. Special arrangements will need to be made for these cases. If you are not on Medicare and would like to come to Houston, make sure we have your insurance information before you come so we can pre-certify your office visit, x-rays, and special MRI. Please do not come to Houston for the actual surgery until you are sure it has been approved by your insurance company. You may fax or email a scanned copy of your insurance or Medicare card to ****Glenda or Gayle at the office, call 713 465-0696 to reach any of them and obtain fax or email information.

Your Hospital Stay

Dr. Likover performs the Signature custom knee replacement procedure Monday thru Thursday. This is not an outpatient procedure. Most patients spend two or three nights in the hospital. All rooms are private, so a spouse can stay with the patient without worrying about requesting a private room.

Pain Reduction

You will be offered the opportunity to have a femoral nerve block and get an ON-Q pump with a continuous flow of “novocaine” around the nerve in the holding area before surgery. Please take advantage of this opportunity to have a major reduction in pain following the surgery.

Recovery After the Signature Knee Replacement Procedure

All patients are treated with a continuous passive motion machine in the hospital and afterwards for two weeks. The machine in rented to you by Therapeutic Solutions (281-317-8227), a Houston medical equipment rental company. Insurance and Medicare covers most of the cost of this rental. Patients are also given home physical therapy and home nursing for two weeks if required; this is also usually covered by insurance and by Medicare. All patients go home with pain pills, usually Hydrocodone and a blood thinner to prevent blood clots in the legs, either Lovenox or Xarelto.

The patient’s responsibility is to obtain full flexion (bending) and full extension (getting your knee all the way straight) after surgery in the hospital and when the patient goes home. You will be furnished a brace to wear at night to keep the knee locked out straight, and to allow full bending during the daytime. The patient may discontinue crutches as fast as possible and may drive when capable. Most patients are pretty limited the first two weeks, after that rapid improvement occurs in the ability to perform most tasks.

Oxford Partial Knee Replacement Procedure: Protocol for Out-of-Town Patients

It is easy to come to Houston for an Oxford implant. Dr. Likover can have you come in on Tuesday and be leaving for home on Thursday. Travel after an Oxford is not a problem, either by air or motor vehicle. An Oxford partial knee replacement is a much smaller operation than total knee replacement. Dr. Likover has had numerous patients come from outside the Houston area. The following explains how our office cares for these patients.

Oxford Insurance Issues:

Medicare covers the Oxford procedure as an inpatient procedure at the hospital. Certain PPO’s and indemnity plans cover it as an outpatient or inpatient procedure. Dr. Likover participates in numerous insurance plans; however, as an “out of towner” Dr. Likover may not be in your network. Dr. Likover is happy to treat patients who have “out of network” benefits within their insurance plan, and will make sure the “out of network” cost is not a burden to the patient. The patient may also pay cash for the Dr. Likover’s bill and use insurance for the hospital bill. We must have your insurance information prior to coming in for an appointment and scheduling surgery so we get surgery pre-certified. Do NOT come to Houston until you are sure your pre-certification for surgery is approved!!! You may fax a photocopy of you insurance card to 713-465-7334 or scan it and e-mail it to either Glenda or Gayle at the office. Please call to get their e-mail addresses. Either of them will answer questions over the phone at 713- 465-0696.

Your Arrival and Hospital Stay

Dr. Likover performs Oxford knee replacement surgeries on Tuesday, Wednesday, and Thursday. Dr. Likover will have seen the x-rays of the patient sent by mail or the internet. Dr. Likover needs to meet the patient in the office for an appointment the day before surgery. Patients usually fly in or drive in for an appointment on Monday or Tuesday, with their surgery scheduled for the following day. A measurement x-ray is usually taken at that appointment. The patient then stays overnight at a hotel or relatives home. On surgery day the patient arrives at Memorial Hermann Memorial City Hospital at 6 a.m. The surgery is performed sometime that day with no guarantee of the time of surgery. The patient then stays in the hospital for two to four days. Most patients return home on Friday or Saturday depending on how far they have to travel.

Recovery After the Oxford Knee Replacement Procedure

The primary instruction to the patient after surgery is to get his or her knee fully straight and fully bent following surgery. Crutches may be discontinued as soon as possible. The patient will be given Vicodin or other medication for pain. All patients will be given a blood thinner, either, Xarelto or Lovenox for ten days following surgery to prevent blood clots in the legs. A continuous passive motion machine (CPM) will be used postoperative for a week, and is provided locally by a rental company, Therapeutic Solutions. The recovery from this surgery is not that difficult, especially compared to a total knee replacement. You may wish to go to physical therapy in your hometown and Dr. Likover will give you a prescription to take to your local therapist.

Coming to Houston: Hotels and Motels

Closest to the Hospital and Office (Four Miles)

  • Omni Hotel 281 558-8338
  • Courtyard by Marriott 281 496-9090

Further, but maybe less expensive (Nine Miles)

  • La Quinta Inn 713 932-0808
  • La Quinta Inn 713 675-2711
  • Red Roof Inn 281 579-7200
  • Hyatt Summer Field Suites 281 646-9990
  • Extended Stay Delux 281 398-6500
  • Super 8 281 646-7800
  • Drury Inn 281 558-7007
  • Holiday Inn 800 470-3431

All Hotels and Motels are along I-10 the Katy Freeway. The Hospital (Memorial Hermann Memorial City) and the outpatient surgery center (Special Surgery of Houston), and Dr. Likover’s office are all along the Katy Freeway.