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Opinion & Analysis

Golfers benefit from new knee replacement technology



Last fall, my father-in-law joined the more than 650,000 total knee replacement patients of 2013[1]. He is a long-time golfer and had been struggling to play due to his moderate to severe knee pain for several years. Finally, the pain was too much to handle and he decided it was time for a knee replacement.

The most common reason golfers have knee replacement surgery is due to osteoarthritis. This is a mechanical condition where the “cushion” of the knee, called cartilage, wears out and the bone rubs against the bone with movement. Osteoarthritis can be very painful and highly agitated by the action of the golf swing.

Despite major advance and modern technology, Jim was one of the growing number of patients that would describe his experience as “traumatic” and “highly disappointing.” Enduring months of severe pain, a revision surgery and still being unable to return to golf after eight months, Jim is now struggling with the decision of whether or not to have his other knee replaced. Is it worth it?

Studies have shown that between 14 and 39 percent of people who have had a knee replacement are “dissatisfied” with their implant or reported “results below their expectations.” (Noble, P et al., Bourne, R et al., Scott, C et al.)

With the demand for total knee replacements expected to rise by 673 percent by the year 2030[2], it is highly likely that you or someone you know will soon be considering your surgical options.

Will you be able to return to an active lifestyle that includes pain free golf or will you be one of the 54,000 U.S. patients needing additional surgery for revisions?

knee replacement complication rateChart from

Fortunately for us, science and technology continue to advance and we can now benefit from a major breakthrough in knee replacements. I recently had the pleasure to interview Dr. Gregory Martin. Dr. Martin is a board certified orthopaedic surgeon who specializes in hip and knee arthritis and other painful disorders and is one of a growing number of surgeons who traded in the traditional total knee protocol in favor of a fully customizable procedure through Conformis Customized Knee Replacements.

Q&A with Martin

In the past, a “custom fit knee replacement” meant that the instruments for fitting the knee were custom for the patient but that the actual knee was an off-the-shelf implant that comes in only a few different sizes. How is Conformis different?

“It’s no different than the fit of a suit coming in a variety of sizes versus the precise fit of a custom suit. Only with a suit, being off in fit by a small amount may not matter, but with an implant, precision fit is critical. People come in all different shapes and sizes and Conformis believes so should their knee implants. Conformis is different because they make customized, individually made implants along with instrumentation specifically made for the patient that helps the surgeon put the implant in correct.

Also, the knee has three parts to it and sometimes they are not all damaged. With Conformis, because a CT SCAN is taken as part of the process, if the patient is found to have damage in only one part or two parts of the knee, then a customized partial knee can be made. Partial knees have had a resurgence in popularity because of the ease of recovery and improved satisfaction.

How can custom fit components make a difference in the outcomes for patients?

Although total knee replacement helps most people, studies show as many as 1 in 5 patients remain not satisfied with their outcome after surgery. Persistent pain after surgery is a major factor in these patients. We now know that implant size plays a significant role in causing persistent pain.

Studies have shown that if an implant is too big by just 3 millimeters, it can double the risk of persistent pain after knee surgery. By making the implants fit precisely, the hope is that we will see higher satisfaction rates, which is what I am seeing in my early data.

What differences can patients expect to experience during rehabilitation?

I have seen my customized knee patients recover in about half the usual time. What I am used to seeing at three months, I now see at six weeks. The patients have less swelling, improved range of motion and function sooner. Why? Because bleeding around the knee and swelling after total knee surgery makes rehabilitation painful and difficult.

With the customized knees, the instrumentation and surgical technique is less traumatic, less bone is removed, and all of the bone that is cut is covered with implant because the fit is precise. So what we see is significantly less bleeding and swelling. Blood transfusions that are fairly common with non-customized total knees (around 10 to 20 percent in most studies) are quite rare with customized total knees (1 percent or less).

knee replacement big

Can patients expect a difference in time in regards to returning to normal daily activities? Returning to more active activities?

Return to daily activities varies from patient to patient, but as a whole, I would say that my customized knee patients generally recover much sooner. I typically can get the customized knee patients out of the hospital either the afternoon of surgery or after one night, versus two to four nights for my non-customized knee patients. I see a lot more people doing activities that they enjoy at six weeks after surgery than I ever saw before.

One patient, who I recently saw at his six-week follow up, comes to mind. He had a non-customized knee I did a few years ago and he did well but took him at least three months to get back to a normal life. When I did his other knee with the Customized implant and saw him back at his six week follow up, he had just got back from a cruise and was dancing with his wife and happier than ever.

For partial knee patients, I have seen many golfing at four to six weeks and total knees at six to eight weeks. This level of activity would be unusual this early for my non-customized knee patients.

What are the advantages of choosing a Conformis custom knee replacement over an off-the-shelf replacement, specifically for golfers wanting to return to sport?

Although recovering quickly is important and we should always look for ways to get people better sooner, what really is more critical is the long-term outcome. Although many patients after total knee replacement are out of pain, they may not be able to do the things that they want to do like golf or other activities. They say the knee doesn’t feel right, it doesn’t feel like their knee.

The thought behind Conformis customized total knees is that by making the implant sized and shaped like the individuals own knee before it was damaged, the knee will feel more natural and allow people to resume more activities that they love to do.

Can you briefly talk about the technological advances that had to occur to allow for a process such as what Conformis is using to advance knee replacements?

Conformis was founded with the idea that modern technology and imaging techniques can be utilized to make better implants. A CT scan is taken to get precise pictures of the knee. The data in that scan is sent to the company and computer automated design (CAD) technology is used to map the knee and create an implant.

The instrumentation, which is all single use and disposable, is created on 3D printers (as opposed to traditional knee instruments which are re-used and must constantly go through re-sterilization). With Conformis, the entire kit is shipped to the hospital in a sterile box with the implant and the instruments. It is 21st Century technology at its best.

osteoarthritis and

Is there anyway to know, prior to surgery, if a person is a better candidate for a custom knee (anyway to know if an off-the-shelf knee would be difficult to fit perfectly)?

We know that people come in all different shapes and sizes on the outside, and their knees look just as different on the inside. Other implant companies have realized this over the years and have created gender specific implants and have increased the number of sizes available with their non-customized knees. However, this may help fit more patients, but will never fit all patients.

Only true customized technology can achieve a perfect fit. After talking with my patients and giving them choices of implants, invariably they wish to have a customized knee. But there are some patients where a customized knee is not appropriate at this time (eg. cases with severe deformities, damage to major knee ligaments, or loss of bony landmarks which would make recreating the knee difficult).

Is there any difference in cost to the consumer when compared to traditional total knee replacement procedure?

Typically in the United States, implant costs are negotiated and covered by the hospitals or insurance companies. Generally, with the exception of any related co-pays for the CT scan required, there are no additional costs to the patient receiving a customized knee implant.

If someone was interested in having a customized knee replacement with the Conformis knee, how should they proceed? 

Visit to learn more about the technology, hear patient’s real experiences and utilize the “find a doctor” feature to find a surgeon using the technology

If patients are interested in your service, what is the best way to contact you or your office?

My practice is in Palm Beach County, Fla., and my information can be found at


In conclusion, the overall success rate of total knee replacements are good. But in my years of physical therapy, I have experienced both the good and the bad. If you are considering a total knee replacement, we have found that the success of the surgery is largely dependent on two factors: the quality of the product and the skill of the surgeon.

As a result, the advice that I always give to golfers considering knee replacement is this:

  1. Visit to find surgeons in your area using this technology.
  2. Get surgeon referrals from two to three local physical therapists who treat patients recovering from total knee replacements. Physical therapists have extensive experience treating the patients of local surgeons and will know which ones have the best results.

If you have any questions or comments, please respond below and we will be happy to respond.

[1] Knee Replacement Statistics:

[2] Arthritis Related Statistics CDC:

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Doctor of Physical Therapy and Certified Golf Performance Specialist, Dr. Ryan York has been working exclusively with golfers between the ages of 50-75 since 2008. York co-directs Age Defying Golf at which is dedicated to improving Golf Performance, reducing the effects of “age”, and resolving golf related pain in golfers between the ages of 50-75.




    Mar 30, 2016 at 5:44 pm

    I went thru a four year period getting uflexxa shots before i knew the only solution to getting back to great golf again was a PKR. I consulted six doctors. I had done my research and knew i only needed a Partial. but the first four doctors i went to tried talking me into a full replacement. Witha full they cut your ACL, MDL and remove your PCL. It will always feel artificial and the recovery is brutal. I was golfing after six weeks. I had a lateral PKR on my right knee-i was bone to bone from a torn worn down menicus. I know have a perfect working right knee that i can “load’ into again and have regained 20 plus yards on my drives and 10 MPH on my swing speed. I hope to regain my scratch hdcp soon.

  2. Pingback: In the News | The Joint Replacement Center of Scottsdale

  3. Patrick

    Jul 2, 2014 at 8:44 pm

    I have had my right knee and left hip replacement. First was my left hip due to a sports injury. I had to donate blood and took a couple of shots of EPO prior to surgery . Great surgeon but having been a professional athlete I was very disciplined on recovery and rehab. My initial goal was to walk without limping. Next was my right knee.
    This was number five on the right knee due to a botched initial surgery 30 years ago. Subsequent surgeries were for cartilage remove and then the dreaded night tibial osteotomy.
    So honestly both surgeries took the better part of five years to be mostly pain free and more importantly, I could walk and golf without pain.
    My advice for those considering either, lose weight and do exactly what the surgeon says. Look at this as an opportunity to get your mobility back. Surgeons are very good these days and want you to do well.

  4. Jim

    Jun 30, 2014 at 3:58 pm

    I’ve had both my knees replaced and am playing as well as I ever have. First, as Nat said, find a good surgeon. I did and I talked to several before choosing. I’ve had no complications at all. Also I agree with Nat that doing your rehab is VITAL. This means at HOME as well as the therapy center. You have to do most rehab on your own. I have good old standard knee replacements but with the modern liners to last longer. My doctor fitting them perfectly and I too was back hitting balls with wedges in about 6 weeks.

  5. Nat

    Jun 29, 2014 at 9:31 am

    I had TKR in November, was back hitting balls in 6 weeks, walking 18 in 3-4 months. I was 50, had no cartilage in my knee since 20 due to college sports injury. This is the best thing I’ve ever done. I am back to elliptical 1 hr a day and golf, typically walking. I won’t lie….it was a hard recovery, but I was extremely diligent with my therapy and stretching. My advice: be in best shape you can be prior to surgery; be prepared to be in pain and work very hard in rehab. It only lasts 3-6 weeks, but the pain is there. Not ouch pain, just generalized discomfort; last, donate blood ahead of time. You lose a lot, and you’ll likely needed a transfusion.
    Also, you do not need a custom knee. That is a gimmick. You need a skilled surgeon who does a lot, a great physical therapist, and a caring spouse.

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Brough Creek National: The backyard course you wish you’d built



Raise your hand if you’ve ever wanted a golf course in your backyard.

Of course you have.

Now leave your hand raised if you actually rolled up your sleeves and made it happen.

Among the very few people left with their hands in the air are Ben Hotaling, Zach Brough, Evan Bissell, and Mark Robinson, the driving force behind Brough Creek National. That’s right. These guys are building a golf course in their backyard. From scratch.

The true beginnings of golf aren’t well-documented, but one thing’s for sure: people were playing golf at least 400 years before the first working internal combustion engine. Long before golf course architecture was a multi-million dollar investment before the first dime of revenue trickled in, courses were laid down largely by hand using the natural movement of the land. In that same spirit, Ben happened to notice that there was one particular shot in their backyard that reminded him of the Road Hole at St. Andrews, as it plays over their barn and to a green situated right in front of the road to the property.

Ben ultimately convinced his roommate Zach, whose family has owned the land for some time, that they should clear some trees and put in a makeshift green for their Road Hole. That was in 2015 and, while that’s technically the genesis of Brough Creek National, it was in 2018 when they started sharing their ideas in No Laying Up’s online forum section that things escalated rather quickly. Bouncing ideas off their fellow compatriots revealed great natural setups for a Biarritz/punch bowl combination, a Redan, and more. Before they knew it, they had a 630-yard, 7-hole golf course criss-crossing through the three-acre property in Kansas City, KS.

Road Hole green at Brough Creek National

Perhaps the most impressive aspect of Brough Creek National is that it has operated solely off of donations, which started with a weed eater here and a can of herbicide there and has since grown to a recent GoFundMe campaign of $15,000. These donations have allowed them to purchase grass seed and other vital equipment to see the project through. The community aspect of Brough Creek National is so important to what they’re trying to achieve that anyone who provides their name and address on the website is sent a free new membership packet (I happen to be member #209). Included are some stickers, a ballmark, and a welcome letter that states (among other things),

“We are proud to have you as a lifetime national member at our exclusive, member-owned (and maintained) club…The vision of Brough Creek National is to have a place for community golf modeled around fun for members and guests from all golfing backgrounds…Your dues will be assessed at the rate of $0.00 annually.”

Ben further emphasizes the importance of the community aspect by saying:

“I think Brough Creek stands for community. It’s like-minded individuals coming together and supporting something they’re proud of. It’s a smart, intriguing golf course, but it’s ultimately about making friends and that’s what matters. The quality of the golf course is almost inconsequential because the real purpose is to assemble this brotherhood of people who are passionate about the game of golf. We think it’s done in a way that sheds the elitist stigma that golf has often struggled with and we’re almost mocking that in a playful way.”

“I’m not going to tell anyone they have to experience the game a certain way, but we try to go above and beyond to be approachable and welcoming because we think that’s more important than status. Golf’s not a money-making business. It’s just not. So, why don’t we just take that out of it, come together as a community, and create something we can all be proud of?”

If we’re all having an honest moment, not even Ben and Zach know exactly how this project is going to evolve, but one thing’s for sure: an emphasis on maximizing fun for the highest number of the golfing community is never a bad place to start. Those who believe par and total yardage are irrelevant in determining the amount of fun available to them should be in for a treat. To watch the project unfold, check out and follow @someguysbackyrd on Twitter and @someguysbackyard on Instagram.

Below is an overview of the course, narrated by Ben Hotaling

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Opinion & Analysis

Brooks Koepka’s coach, Claude Harmon III, on BK’s PGA Championship victory, working with the game’s best, and more



Coming fresh off the celebration of Brooks Koepka’s fourth major win, Koepka’s long-time coach, Claude Harmon III chatted with Johnny Wunder as he was just about to hop on a plane back to The Floridian.

Here are the highlights of their conversation.

JW: Claude how you doin’?

CH3: Uh, I’m hungover!

JW: Brooks is walking off the 18th green after another major triumph. What is the first thing you guys said to each other?

CH3: Well, obviously there was a lot of emotion in that moment, but he told me it was the happiest he has ever been on the golf course, and after everything he’s done, that’s a big statement.

For him to put in all the hard work and to fight as hard as he did on a golf course that completely changed on the last day and come out on top makes me extremely grateful to be a part of the team that supports that. I believe he will find out more about himself from getting through the final nine holes than he would if he would have had a parade coming in and won by seven.

JW: That’s a great point. It seems like he is more apt to win even more majors based on that back nine than he would have otherwise.

CH3: I don’t think if you were watching it on TV you could have any appreciation for just how difficult it was. What DJ did yesterday was impossible and having that up ahead applies even more pressure to a leader. Ricky Elliott and BK are looking at the scoreboard and seeing DJ and 3 under and having no idea how that’s even possible. It was that tough.

JW: I think Brooks stubbornness is part of his true greatness. Would you agree?

CH3: His perspective constantly was “I’m still in the lead and someone is going to have to catch me and this golf course is extremely difficult.” Even after all the bogeys on the back side, he still controlled the lead and kept that mantra. The crowd yelling “DJ! DJ!” actually didn’t piss him off, it woke him up and made him want to hit a good drive and show the crowd he was still leading.

JW: How did yesterday compare to Shinnecock? 

CH3: At Shinnecock it was an interesting situation because Fleetwood…posted before BK was even off and in that case, Brooks said it was like playing against a ghost. No matter what he does, Tommy isn’t going to make any more mistakes or change in any way. That’s a tough scenario when you are staring at a number that won’t move for 5 1/2 hours.

JW: What do Brooks and DJ have that people can learn from.

CH3: It’s funny because we hear these cliches in sports psychology all the time, but I believe those two are the living embodiment of ONE SHOT AT A TIME. They don’t look back. Ever.

JW: Speaking on DJ. I’m watching the back nine and thinking to myself this guy is playing out of his mind, it was literally a battle of the best.

CH3: We talk about it all the time in golf, what we always want is the two best players in the world going toe to toe. We had that yesterday and I hope as time goes by we can look at this final round as a battle we will be talking about for a long time. Best players in the world on a tough but fair golf course with the ultimate prize on the line. In situations like this when there is this kind of pressure and these stakes you can look at the leaderboard and see the cream rising to the top. Rory, DJ, Jordan all with good rounds on a really tough day.

JW: You met Brooks in 2013, he showed up in his mom’s beat up Explorer and don’t know him at all. What was your first impression?

CH3: I was introduced to him by Pete Uihlein, his old roommate, and at first glance, he had raw talent and a ton of speed, but no plan. At the time he was hitting a draw and was uncomfortable with that. He told me his current coach wanted him to hit draws, and I said well that’s your fault, not your coach’s. It’s the player’s responsibility to manage himself and the information he’s comfortable with. When we worked on him getting into a fade, he started to click and he turned to me and said “it can’t be this easy.” My reply was “it has to be this easy!” At that level, under the gun, it better be easy. [Golf is] tough enough already.

JW: What were his career goals early on?

CH3: Even then, he wanted to be an elite player who won multiple majors. I was coaching Ernie Els at the time who had just won his fourth major and Brooks was on the Challenge Tour. He was committed to getting there but needed guidance, someone with a plan that wasn’t just his golf swing. Obviously, it worked out.

JW: What would you say is the Harmon secret to getting the best players in the world to peak as often as you guys do?

CH3: My dad told me: “What you don’t say is just as important as what you do say.” At the Masters this year Brooks, in practice, was really struggling. Look, it’s Masters week and I’m not going to go in there and start putting thoughts in his head. At that point, if this is a shuttle launch, we are in the cockpit and there is no turning back. My dad always had his guys have a go-to shot that they “knew” they could hit. Brooks calls it his “fairway finder” which is a squeeze off fade with a driver. I told him to hit a couple of those knowing it might spur some confidence. After a few absolutely flushed missiles, his confidence went up and he turned to me and said…”fairway finder all day.” The rest is history.

JW: You coach DJ, Brooks, Jimmy Walker and Rickie. Describe each in one word

CH3: Natural

JW: Brooks
CH3: Tough MF

JW: Rickie
CH3: Genuine

JW: Jimmy
CH3: Soulful

JW: Thanks old friend
CH3: Talk soon, thanks man.

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On Spec: Swing weight is overrated



A deep dive into one of the most talked about but truly misunderstood aspects of club building: swing weight. What it really means, and why it isn’t the end all be all for a set of clubs.

Check out the full podcast on SoundCloud below, or click here to listen on iTunes or here to listen on Spotify.

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19th Hole