How 4,000 Hours of Patient Education Transformed My Practice
Written by: Dr. Brian Hatten, M.D. | Board-Certified Orthopedic Surgeon | Last Updated: January 12, 2026
From Educating to Listening
In 2012, I began what would become a three-year commitment to patient education. I fit approximately 4,000 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. The platform was later recognized in medical literature when orthopedic surgeons Matthew DiPaola, MD and Orrin I. Franko, MD published a review in Healio Orthopedics documenting its comprehensive educational approach and clinical utility.
To put that in perspective: My Knee Guide took approximately 2,500-3,000 hours. BoneSmart, another 1,300. Combined, that's roughly 4,000 hours, the equivalent of two full years of full-time work compressed into three years alongside my surgical practice performing hundreds of joint replacements annually.
Creating My Knee Guide was not about marketing myself. When I started, there simply wasn't good online patient education available for knee replacement. I built it 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.
That philosophy guides everything I do today.
From Teaching Patients to Teaching Surgeons
The same commitment now shapes how I teach fellow surgeons through online communities like DocMatter, hands-on training in the operating room, and national conferences.
In January 2026, I co-presented a 60-minute surgical demonstration through Johnson & Johnson MedTech's VELYS Community on DocMatter, a peer-to-peer medical collaboration platform where orthopedic surgeons share clinical insights and techniques. Alongside fellow kinematic alignment specialist Dr. Josh Lindsey, we guided surgeons nationwide through a complete VELYS robotic-assisted total knee replacement using the subvastus approach with kinematic alignment, demonstrating the exact bony landmarking, planning parameters, and surgical techniques I use on every patient in my practice.
But formal presentations are just part of it. 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. The audience has changed from patients to surgeons, but the commitment to collaborative learning remains the same.
This isn't promotional content. It's peer education. The 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.
So what are these techniques, and why do they matter to you?
From Teaching Patients to Teaching Surgeons
The same commitment now shapes how I teach fellow surgeons through online communities like DocMatter, hands-on training in the operating room, and national conferences.
In January 2026, I co-presented a 60-minute surgical demonstration through Johnson & Johnson MedTech's VELYS Community on DocMatter, a peer-to-peer medical collaboration platform where orthopedic surgeons share clinical insights and techniques. Alongside fellow kinematic alignment specialist Dr. Josh Lindsey, we guided surgeons nationwide through a complete VELYS robotic-assisted total knee replacement using the subvastus approach with kinematic alignment, demonstrating the exact bony landmarking, planning parameters, and surgical techniques I use on every patient in my practice.
But formal presentations are just part of it. 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. The audience has changed from patients to surgeons, but the commitment to collaborative learning remains the same.
This isn't promotional content. It's peer education. The 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.
So what are these techniques, and why do they matter to you?
The evidence supporting kinematic alignment has grown substantially. A 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.
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 platform.
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 alignment. My role involves advising on both robotic and instrumented versions of these procedures, helping determine how this technique evolves and is taught nationwide.
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're a smoker, I'll explain how that increases complication rates. 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.
This approach resonates with patients. They've rated their experience an average of 4.8 out of 5 stars across over 300 verified reviews on Google, Healthgrades, Vitals, Sharecare, and RateMDs.
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 performed my first knee replacement in 2004 and served as Chief of Orthopedic Surgery at Halifax Medical Center. Since January 2025, I have served as Vice President of East Coast Surgery Center (operating as The Orthopedic Clinic 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 sports m 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 completely preserves your quadriceps muscle and tendon. Unlike traditional techniques that cut through or detach this critical muscle, the subvastus technique accesses your knee joint from beneath the muscle, leaving it entirely intact. This means faster strength recovery, less post-operative pain, and better outcomes. I use this approach on all my patients, regardless of whether you're bow-legged, knock-kneed, or have neutral alignment. There are no restrictions, no limitations. Just a muscle-sparing technique that works for everyone. 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. 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. Kinematic alignment takes the opposite approach. 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 of your knee. 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.Surgical Techniques: Subvastus Approach & Kinematic Alignment
The Subvastus Approach: Preserving Your Muscle
Kinematic Alignment: Personalizing Your Surgery
Professional Credentials:
- Florida Medical License: ME88918 (Active, no disciplinary actions) - Verify license status (search by license number ME88918 or name "Brian Hatten")
- National Provider Identifier (NPI): 1073592788 - Verify NPI
- Board Certification: American Board of Orthopaedic Surgery (July 2006 - December 2036)
For complete details about my credentials, affiliations, and professional background, visit my profile at The Orthopedic Clinic.
Industry Relationships and Transparency
I receive compensation for my advisory role with Johnson & Johnson MedTech and for my teaching activities, including education on surgical techniques using the VELYS Robotic-Assisted Solution. I encourage patients to ask about these relationships and welcome second opinions.
Note: VELYS is manufactured by DePuy Synthes, the orthopedics company of Johnson & Johnson. In September 2024, Johnson & Johnson consolidated its medical technology brands under the name Johnson & Johnson MedTech. In October 2025, Johnson & Johnson announced its intent to spin off DePuy Synthes as an independent company, with the separation expected to complete in 2027. References to "Johnson & Johnson MedTech" and "DePuy Synthes" in this article refer to the same orthopedics division and product line. My advisory and teaching roles are expected to continue through this transition.
Practice Locations and Contact
I practice at The Orthopedic Clinic's locations in Daytona Beach, Port Orange, and Palm Coast, serving patients throughout Volusia and Flagler Counties. I've been with The Orthopedic Clinic since 2004.
The Orthopedic Clinic - Daytona Beach (Primary Location)
1865 LPGA Blvd
Daytona Beach, FL 32117
Phone: (386) 255-4596
Fax: (386) 258-3561
The Orthopedic Clinic - Port Orange
1165 Dunlawton Ave, Suite 102
Port Orange, FL 32127
Phone: (386) 255-4596
The Orthopedic Clinic - Palm Coast
17 Old Kings Road N., Suite K
Palm Coast, FL 32137
Phone: (386) 255-4596
I perform surgeries at AdventHealth Daytona Beach, Halifax Health Medical Center, and The Orthopedic Clinic Surgery Center.
Resources to Help You Decide
If you're considering joint replacement surgery or want to learn more about your options, I encourage you to explore the free educational resources I've created:
For Knee Replacement:
- Learn about knee alignment techniques to understand how implant positioning affects your outcome
- See real patient x-rays in the X-Ray Vision Center, where I've animated six cases showing the progression from arthritis through surgery
- Review what to expect from surgery and your recovery journey
- Follow the home exercise program I created to guide your rehabilitation
Ready to Talk?
Deciding to have joint replacement or orthopedic surgery is a major decision. There's no rush. Take your time. Gather information. Ask questions. Explore your options.
When you're ready, or if you're just starting to explore whether you might need surgery, call The Orthopedic Clinic at (386) 255-4596 to schedule a consultation.
After two decades of performing joint replacements, investing thousands of hours in patient education, and teaching other surgeons advanced techniques, I've learned that the best outcomes happen when patients are informed, prepared, and actively engaged in their care.
That's the kind of partnership I offer. If that approach resonates with you, I'd be honored to be part of your orthopedic care journey.
For complete credentials and additional information, visit mykneeguide.com/dr-brian-hatten



