About Dr. Brian Hatten | Board-Certified Orthopedic Surgeon

From Educating to Listening

In 2012, I began what would become a three-year commitment to patient education. I fit thousands of hours of work into nights, weekends, and every spare moment while maintaining my full-time surgical practice.

In January 2012, I started developing My Knee Guide, a comprehensive patient education platform. Two months later, in March 2012, I began volunteering as "Orthodoc" on BoneSmart.org, the world's largest joint replacement patient forum. What I didn't expect was how BoneSmart would transform my understanding of the patient experience.

On BoneSmart, I contributed 648 posts as "Orthodoc," a role that evolved into a volunteer staff position as I became part of the community. I answered questions from patients I'd never meet and would never be paid to treat. Because I was anonymous to the members, the conversations weren't about me. They were about the patients and their experiences. Over three years, I came to know many members well. I shared in their fears, their recoveries, their setbacks, their victories. I became a better listener.

I also learned from the moderators and volunteers who ran the forum. They created a safe, welcoming, and encouraging environment for every patient who joined. They were some of the most compassionate and dedicated people I've encountered. They modeled what patient-centered care looks like in practice: meeting people where they are, answering the questions they're actually asking, and never talking down to someone facing a major health decision. That philosophy shaped everything I do today.

That philosophy guided how I built My Knee Guide. I personally wrote every piece of medical content: over 60 comprehensive articles covering every aspect of knee replacement. I used Photoshop to create unique x-ray animations for six patient cases, spending weeks on each to animate real patient x-rays showing the progression from arthritis through surgery. I produced educational videos, designed custom graphics, and collaborated with developers on both the iPhone app and website.

Creating My Knee Guide was not about marketing myself. When I began the project, there simply wasn't good online patient education created by an orthopedic surgeon to help patient navigate knee arthritis and knee replacement surgery. I built My Knee Guide because I believe patients deserve comprehensive, transparent information from someone who actually performs these surgeries, regardless of whether they ever become my patient.

Those three years taught me that patients don't just need technical excellence in the operating room. They need a surgeon who treats them as an informed partner in their care, who explains rather than dictates, who listens rather than dismisses.

This commitment extended to medication safety as well. After knee replacement, patients are commonly prescribed pain medications that contain acetaminophen — medicines like Lortab, Percocet, Vicodin, Norco, and Ultracet. What many patients don't realize is that they may also be taking over-the-counter products containing acetaminophen at the same time, putting them at risk of exceeding the 4,000 mg daily maximum without knowing it. Because I prescribe these medications to my own patients, I felt a responsibility to address this directly. In 2016, My Knee Guide partnered with the Acetaminophen Awareness Coalition's Know Your Dose campaign to provide dedicated education on safe acetaminophen use after knee replacement surgery.

Since its launch, My Knee Guide has been independently cited, evaluated, or utilized in nine peer-reviewed studies and clinical reviews conducted by researchers and clinicians across four continents. An NIH-funded randomized controlled trial selected the platform as its clinical baseline. A systematic quality assessment ranked it the highest-rated joint replacement app in the world. The premier journal for sports medicine featured it as clinical guidance for returning athletes to activity. And in 2024, a government-supported health evaluation service in New Zealand conducted a structured clinical review and affirmed the platform’s utility for an international patient population. These independent validations, spanning institutions across the United States, United Kingdom, Ireland, Australia, Austria, Germany, India, and New Zealand, reflect the platform’s role as a globally recognized resource for patient education in knee replacement surgery. A complete list of these studies with links to each publication can be found in the My Knee Guide in the Literature section at the end of this article.

From Teaching Patients to Teaching Surgeons

This commitment to patient education now shapes how I teach fellow surgeons with hands-on training in the operating room, and at national conferences. I also routinely collaborate with other surgeons on the Depuy Synthes (Johnson & Johnson MedTech) VELYS Community on DocMatter, a peer-to-peer medical collaboration platform where orthopedic surgeons share clinical insights and techniques . I spend time in the VELYS Community the same way I once spent time on BoneSmart. I ask questions, answer them, troubleshoot challenges, and learn alongside peers who are refining these techniques in their own practices. This kind of transparent, evidence-based teaching that defined my career when I answered patient questions on BoneSmart, when I created educational content for My Knee Guide, and now when I demonstrate surgical techniques to fellow surgeons. The commitment remains the same: share what works, follow the evidence, and help people make informed decisions.

In January 2026, I had the privilege to co-present a 60-minute surgical demonstration, alongside fellow kinematic alignment specialist Dr. Josh Lindsey. I guided surgeons nationwide through the subvastus approach1. We then demonstrated and discussed a complete VELYS robotic-assisted with kinematically aligned total knee replacement.

Robotic-Assisted Technology: VELYS & Mako Systems

When combined with robotic-assisted technology, primarily using the VELYS system (though I'm also trained on other platforms including Mako), kinematic alignment allows me to deliver precision surgery that respects your body's natural biomechanics down to the millimeter.

Leading the Evolution of These Techniques

I adopted the subvastus approach and kinematic alignment after reviewing the evidence and seeing the results in my own practice. These aren't separate techniques I use selectively. They're fully integrated components of my surgical approach.

My surgical experience with these integrated techniques earned national recognition, leading to my selection as teaching faculty at the 2025 AAHKS National Conference. AAHKS represents the highest level of joint replacement expertise: fellowship-trained surgeons dedicated exclusively to hip and knee surgery. In a session sponsored by Johnson & Johnson MedTech, I taught a hands-on cadaver dissection demonstrating the subvastus approach and kinematic alignment using the VELYS robotic platform2.

I was also selected to serve on the Johnson & Johnson MedTech Kinematic Alignment Advisory Board in July 2024, joining a select group of surgeons providing guidance that directly shapes industry standards for kinematic alignment3. My role involves advising on both robotic and instrumented versions of these procedures, helping determine how this technique evolves and is taught nationwide.

Surgical Techniques: Subvastus Approach & Kinematic Alignment

Since 2024, I've performed every knee replacement using two complementary techniques that work together: the subvastus approach and kinematic alignment. This represents a fundamental change in how I approach the surgery.

The Subvastus Approach: A Legacy of Anatomical Stewardship

The subvastus approach represents a commitment to anatomical stewardship that dates back nearly a century. First described by German surgeon F. Erkes4 in 1929, the technique was designed to preserve the integrity of the quadriceps mechanism by accessing the joint from beneath the muscle rather than through it.

While traditional methods often split or detach these critical tissues, this "muscle-sparing" philosophy was refined for the modern era by Dr. Aaron Hofmann5, who reintroduced the "Southern" subvastus approach in 1991. Hofmann’s work proved that by leaving the extensor mechanism entirely intact, patients could achieve significantly faster strength recovery and reduced post-operative pain.

I have fully integrated this lineage into my practice, performing every knee replacement using the subvastus technique. By respecting the native anatomy as Erkes and Hofmann envisioned, I treat your quadriceps muscle as an essential asset to be protected, ensuring the most natural feel and function for your new knee.

So far, I have discussed the subvastus approach. However, there are several different surgical approach techniques9 to access the knee for a knee replacement. The most traditional is the medial parapatellar approach10. This is the approach that I used for nearly two decades. This approach is technically the easiest and provides excellent exposure. It does require closure of the vastus medialis muscle back to its insertion site once the surgery has been completed. Another approach option is the mid vastus approach11. In this approach part of the vastus medialis muscle is split to obtain access.

Instead, I choose the subvastus approach as it retains complete integrity of all the entire quadriceps muscle. I have also refined this technique to avoid undermining the skin, preventing the creation of skin flaps. This provides better health to the skin and promotes healing. Performing the subvastus approach on every patient is technically the most demanding of the approach techniques. I do find that about one third of the surgeries will take an extra couple minutes to make this technique fully successful. However, I feel that it is time well spent on the patient.

Kinematic Alignment: Personalizing Your Surgery

While the subvastus approach addresses how I access your knee, kinematic alignment determines how I position your implants. This is where my work becomes truly personalized. But, first let's discuss the other alignment techniques6: mechanical alignment7 and functional alignment8.

Traditional mechanical alignment takes a standardized approach: it creates a straight leg with components positioned to bring the mechanical axis (an imaginary line from hip to ankle) through the center of the knee, regardless of your natural anatomy. This method produces reproducible results but often requires selective ligament releases to achieve balance, and sometimes a completely natural ligament balance cannot be fully achieved.

Functional alignment focuses on achieving a well-balanced knee by assessing the ligament and the soft tissue envelope tension of the knee during surgery. This alignment method has become much more popularized with the increased use of robotic and navigated technologies. Rather than relying on fixed mechanical axes or pre-arthritic measurements, the surgeon evaluates ligament tension intraoperatively.

Kinematic alignment works by aligning the components so the knee moves around its original three-dimensional axes. By respecting your original joint line orientation and limb alignment, the ligaments remain naturally balanced without the need for releases. It restores your knee to its pre-arthritic anatomy, respecting your body's unique biomechanics.

Not everyone is born with a straight leg. About 30% of people are naturally bow-legged, 15% are knock-kneed, and 55% are relatively straight. Joint line orientation also varies, with some parallel to the floor and others sloped. These differences matter because they create the uniqueness to the knee, and the goal of kinematic alignment is to replicate this.

In 2024, I developed my kinematic alignment philosophy by combining extensive research and numerous collaborations with colleagues and experts. Rooted in the pioneering research of Dr. Stephen Howell6, kinematic alignment3 allows me to resurface the knee to your unique, pre-arthritic anatomy. When combined with the VELYS robotic platform, this approach delivers precision surgery that respects your body’s natural biomechanics down to the millimeter.

The evidence supporting kinematic alignment has been growing substantially. An example is the 2025 meta-analysis by Boutros and colleagues, analyzing randomized controlled trials, found that kinematic alignment yields clinical outcomes at least equivalent to mechanical alignment, with statistically significant improvements in early function, joint awareness, and patient satisfaction, without increased risk of complications or revision.

What You Can Expect When You're My Patient

When you come to my office with knee, hip, or shoulder pain, I'm not going to immediately schedule surgery. We're going to have a conversation about your quality of life, your goals, and your options.

We'll discuss conservative treatments first: activity modification, medications, injections, bracing, physical therapy. We'll look at your imaging together, and I'll show you exactly what's happening in your joint. I'll explain what the images mean in plain language, not medical jargon.

If you do need surgery, I'll explain the specific techniques I use and how they differ from other approaches. For knee replacement, that means discussing the subvastus approach and kinematic alignment. For hip replacement, the anterior approach. For shoulders, whether an arthroscopic repair or replacement makes sense. I'll answer your questions about recovery timelines and realistic expectations.

I'll also be honest about risk factors. If you have significant medical conditions, we'll discuss whether surgery is the right choice or if we should pursue other options.

Throughout this process, I'll encourage you to be an active participant in your care: asking questions, understanding your options, and taking the time you need.

Because ultimately, this is your body and your life. My job is to provide expertise, transparency, and partnership. Your job is to make the decision that's right for you.

My Practice Philosophy

Listen first. Your experience matters more than my assumptions. Before recommending anything, I need to understand your pain, your goals, and your concerns.

Explain everything. You deserve to understand the reasoning behind my recommendations, not just follow instructions. I use plain language because jargon doesn't help anyone.

Be honest. I'll tell you the truth about risks, realistic outcomes, and whether surgery is even the right choice. Reassurance without honesty isn't helpful.

Respect your autonomy. This is your body and your decision. I'll never pressure you into surgery or rush you toward a choice you're not ready to make. Take the time you need. I'm here when you're ready.

These principles guide every patient interaction, whether you're seeing me for a knee, a hip, or another orthopedic concern.

Credentials and Training

I graduated from Cornell University's College of Agriculture and Life Sciences as a Howard Hughes Medical Institute Scholar. At New York University School of Medicine, I graduated with honors in 1999 and was inducted into the Alpha Omega Alpha Medical Honor Society, the national medical honor society recognizing academic excellence and professionalism.

My orthopedic surgery residency at Jackson Memorial Hospital/University of Miami from 1999-2004 provided comprehensive training at one of the nation's premier Level I trauma centers. I joined The Orthopedic Clinic immediately after completing residency and have maintained continuous board certification since 2006.

I'm a Fellow of both the American Academy of Orthopaedic Surgeons (since March 2008) and the American Association of Hip and Knee Surgeons (since August 2016). I served as Chief of Orthopedic Surgery at Halifax Medical Center. Since 2025, I have served as Chief Medical Officer of The Orthopedic Clinic Surgery Center ( previously known as the East Coast Surgery Center ), where I have been a partner since its founding, collaboratively developing surgical protocols and clinical excellence standards with my orthopedic colleagues.

Beyond knee replacement, I bring the same precision and personalized approach to every joint I treat. I perform hip replacements using the anterior approach with VELYS Hip Navigation for precise component positioning. For shoulder conditions, I perform arthroscopic rotator cuff repairs and both anatomic and reverse total shoulder replacements, using CT-based planning for patient-specific surgical guides. My practice also includes other sports medicine procedures such as arthroscopic knee procedure, biceps tendon repairs, and tennis elbow repairs. I have also performed 20 years of Level II trauma call coverage at Halifax Medical Center, including the orthopedic surgical management of complex multi-trauma patients.