Opinion & Analysis

Golfers benefit from new knee replacement technology

Published

10 years ago

Jun 27, 2014

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?

Chart from www.healthline.com

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).

www.healthline.com

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.

www.healthline.com

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 www.myconformisknee.com 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 www.floridajointreplacement.com

——————————————————-

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:

Visit www.myconformisknee.com to find surgeons in your area using this technology.
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: http://www.healthline.com/health/total-knee-replacement-surgery/statistics-infographic

[2] Arthritis Related Statistics CDC: http://www.cdc.gov/arthritis/data_statistics/arthritis_related_stats.htm

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Opinion & Analysis

The Wedge Guy: What really makes a wedge work? Part 1

Published

1 day ago

Apr 18, 2024

Terry Koehler

Of all the clubs in our bags, wedges are almost always the simplest in construction and, therefore, the easiest to analyze what might make one work differently from another if you know what to look for.

Wedges are a lot less mysterious than drivers, of course, as the major brands are working with a lot of “pixie dust” inside these modern marvels. That’s carrying over more to irons now, with so many new models featuring internal multi-material technologies, and almost all of them having a “badge” or insert in the back to allow more complex graphics while hiding the actual distribution of mass.

But when it comes to wedges, most on the market today are still single pieces of molded steel, either cast or forged into that shape. So, if you look closely at where the mass is distributed, it’s pretty clear how that wedge is going to perform.

To start, because of their wider soles, the majority of the mass of almost any wedge is along the bottom third of the clubhead. So, the best wedge shots are always those hit between the 2nd and 5th grooves so that more mass is directly behind that impact. Elite tour professionals practice incessantly to learn to do that consistently, wearing out a spot about the size of a penny right there. If impact moves higher than that, the face is dramatically thinner, so smash factor is compromised significantly, which reduces the overall distance the ball will fly.

Every one of us, tour players included, knows that maddening shot that we feel a bit high on the face and it doesn’t go anywhere, it’s not your fault.

If your wedges show a wear pattern the size of a silver dollar, and centered above the 3rd or 4th groove, you are not getting anywhere near the same performance from shot to shot. Robot testing proves impact even two to three grooves higher in the face can cause distance loss of up to 35 to 55 feet with modern ‘tour design’ wedges.

In addition, as impact moves above the center of mass, the golf club principle of gear effect causes the ball to fly higher with less spin. Think of modern drivers for a minute. The “holy grail” of driving is high launch and low spin, and the driver engineers are pulling out all stops to get the mass as low in the clubhead as possible to optimize this combination.

Where is all the mass in your wedges? Low. So, disregarding the higher lofts, wedges “want” to launch the ball high with low spin – exactly the opposite of what good wedge play requires penetrating ball flight with high spin.

While almost all major brand wedges have begun putting a tiny bit more thickness in the top portion of the clubhead, conventional and modern ‘tour design’ wedges perform pretty much like they always have. Elite players learn to hit those crisp, spinny penetrating wedge shots by spending lots of practice time learning to consistently make contact low in the face.

So, what about grooves and face texture?

Grooves on any club can only do so much, and no one has any material advantage here. The USGA tightly defines what we manufacturers can do with grooves and face texture, and modern manufacturing techniques allow all of us to push those limits ever closer. And we all do. End of story.

Then there’s the topic of bounce and grinds, the most complex and confusing part of the wedge formula. Many top brands offer a complex array of sole configurations, all of them admittedly specialized to a particular kind of lie or turf conditions, and/or a particular divot pattern.

But if you don’t play the same turf all the time, and make the same size divot on every swing, how would you ever figure this out?

The only way is to take any wedge you are considering and play it a few rounds, hitting all the shots you face and observing the results. There’s simply no other way.

So, hopefully this will inspire a lively conversation in our comments section, and I’ll chime in to answer any questions you might have.

And next week, I’ll dive into the rest of the wedge formula. Yes, shafts, grips and specifications are essential, too.

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Golf's Perfect Imperfections

Golf’s Perfect Imperfections: Amazing Session with Performance Coach Savannah Meyer-Clement

Published

1 day ago

Apr 18, 2024

GolfWRX Staff

In this week’s episode, we spent some time with performance coach Savannah Meyer-Clement who provides many useful insights that you’ll be able to implement on the golf course.

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19th Hole

Vincenzi’s 2024 RBC Heritage betting preview: Patrick Cantlay ready to get back inside winner’s circle

Published

4 days ago

Apr 15, 2024

Matt Vincenzi

Just a two-hour drive from Augusta National, the PGA TOUR heads to Harbour Town Golf Links in Hilton Head Island, S.C. Hilton Head Island is a golfer’s paradise and Harbour Town is one of the most beautiful and scenic courses on the PGA TOUR.

Harbour Town Golf Links is a par-71 that measures 7,121 yards and features Bermuda grass greens. A Pete Dye design, the course is heavily tree lined and features small greens and many dog legs, protecting it from “bomb-and-gauge” type golfers.

The field is loaded this week with 69 golfers with no cut. Last year was quite possibly the best field in RBC Heritage history and the event this week is yet another designated event, meaning there is a $20 million prize pool.

Most of the big names on the PGA Tour will be in attendance this week with the exceptions of Hideki Matsuyama and Viktor Hovland. Additionally, Webb Simpson, Shane Lowry, Gary Woodland and Kevin Kisner have been granted sponsors exemptions.

Past Winners at Harbour Town

2023: Matt Fitzpatrick (-17)
2022: Jordan Spieth (-13)
2021: Stewart Cink (-19)
2020: Webb Simpson (-22)
2019: CT Pan (-12)
2018: Sotoshi Kodaira (-12)
2017: Wesley Bryan (-13)
2016: Branden Grace (-9)
2015: Jim Furyk (-18)

In this article and going forward, I’ll be using the Rabbit Hole by Betsperts Golf data engine to develop my custom model. If you want to build your own model or check out all of the detailed stats, you can sign up using promo code: MATTVIN for 25% off any subscription package (yearly is best value).

Key Stats For Harbour Town

Let’s take a look at key metrics for Harbour Town Golf Links to determine which golfers boast top marks in each category over their past 24 rounds.

Strokes Gained: Approach

Strokes Gained: Approach is exceedingly important this week. The greens at Harbour Town are about half the size of PGA TOUR average and feature the second-smallest greens on the tour. Typical of a Pete Dye design, golfers will pay the price for missed greens.

Total SG: Approach Over Past 24 Rounds

Scottie Scheffler (+1.27)
Tom Hoge (+1.27)
Corey Conners (+1.16)
Austin Eckroat (+0.95)
Cameron Young (+0.93)

Good Drive %

The fairways at Harbour Town are tree lined and feature many dog legs. Bombers tend to struggle at the course because it forces layups and doesn’t allow long drivers to overpower it. Accuracy is far more important than power.

Good Drive % Over Past 24 Rounds

Brice Garnett (88.8%)
Shane Lowry (+87.2%)
Akshay Bhatia (+86.0%)
Si Woo Kim (+85.8%)
Sepp Straka (+85.1%)

Strokes Gained: Total at Pete Dye Designs

Pete Dye specialists tend to play very well at Harbour Town. Si Woo Kim, Matt Kuchar, Jim Furyk and Webb Simpson are all Pete Dye specialists who have had great success here. It is likely we see some more specialists near the top of the leaderboard this week.

SG: TOT Pete Dye per round over past 36 rounds:

Xander Schauffele (+2.27)
Scottie Scheffler (+2.24)
Ludvig Aberg (+2.11)
Brian Harman (+1.89)
Sungjae Im (+1.58)

4. Strokes Gained: Short Game (Bermuda)

Strokes Gained: Short Game factors in both around the green and putting. With many green-side bunkers and tricky green complexes, both statistics will be important. Past winners — such as Jim Furyk, Wes Bryan and Webb Simpson — highlight how crucial the short game skill set is around Harbour Town.

SG: SG Over Past 24 Rounds

Jordan Spieth (+1.11)
Taylor Moore (+1.02)
Wyndham Clark (+0.98)
Mackenzie Hughes (+0.86)
Andrew Putnam (+0.83)

5. Greens in Regulation %

The recipe for success at Harbour Town Golf Links is hitting fairways and greens. Missing either will prove to be consequential — golfers must be in total control of the ball to win.

Greens in Regulation % over past 24 rounds:

Brice Garnett (+75.0%)
Scottie Scheffler (+69.9%)
Corey Conners (+69.0%)
Shane Lowry (+68.3%)
Patrick Rodgers (+67.6%)

6. Course History

Harbour Town is a course where players who have strong past results at the course always tend to pop up.

Course History over past 24 rounds:

Patrick Cantlay (+2.34)
Cam Davis (+2.05)
J.T. Poston (+1.69)
Justin Rose (+1.68)
Tommy Fleetwood (+1.59)

The RBC Heritage Model Rankings

Below, I’ve compiled overall model rankings using a combination of the five key statistical categories previously discussed — SG: Approach (24%), Good Drives (20%), SG: SG (14%), SG: Pete Dye (14%), GIR (14%), and Course History (14%)

Shane Lowry
Russell Henley
Scottie Scheffler
Xander Schauffele
Corey Conners
Wyndham Clark
Christiaan Bezuidenhout
Matt Fitzpatrick
Cameron Young
Ludvig Aberg

2024 RBC Heritage Picks

Patrick Cantlay +2000 (FanDuel)

With the exception of Scottie Scheffler, the PGA Tour has yet to have any of their star players show peak form during the 2024 season. Last week, Patrick Cantlay, who I believe is a top-5 players on the PGA Tour, took one step closer to regaining the form that’s helped him win eight events on Tour since 2017.

Cantlay limped into the Masters in poor form, but figured it out at Augusta National, finishing in a tie for 20th and ranking 17th for the week in Strokes Gained: Ball Striking. The former FedEx Cup champion will now head to one of his favorite golf courses in Harbour Town, where he’s had immaculate results over the years. In his six trips to the course, he’s only finished worse than 7th one time. The other finishes include three third places (2017, 2019, 2023) and one runner-up finish (2022). In his past 36 rounds at Harbour Town, Cantlay ranks 1st in Strokes Gained: Total per round at the course by a wide margin (+2.36).

Cantlay is winless since the 2022 BMW Championship, which is far too long for a player of his caliber. With signs pointing to the 32-year-old returning to form, a “signature event” at Harbour Town is just what he needs to get back on the winning track.

Tommy Fleetwood +3000 (FanDuel)

I truly believe Tommy Fleetwood will figure out a way to win on American soil in 2024. It’s certainly been a bugaboo for him throughout his career, but he is simply too talented to go another season without winning a PGA Tour event.

At last week’s Masters Tournament, Fleetwood made a Sunday charge and ended up finishing T3 in the event, which was his best ever finish at The Masters. For the week, the Englishman ranked 8th in the field in Strokes Gained: Approach, 10th in Strokes Gained: Ball Striking and 16th in Strokes Gained: Putting.

Harbour Town is a perfect layout for Fleetwood, and he’s had relative success at this Pete Dye design in the past. In his four trips to the course, he’s finished inside of the top 25 three times, with his best finish, T10, coming in 2022. The course is pretty short and can’t be overpowered, which gives an advantage to more accurate players such as Fleetwood. Tommy ranks 8th in the field in Good Drive % and should be able to plot his way along this golf course.

The win is coming for Tommy lad. I believe there’s a chance this treasure of a golf course may be the perfect one for him to finally break through on Tour.

Cameron Young +3300 (FanDuel)

Cameron Young had a solid Masters Tournament last week, which is exactly what I’m looking for in players who I anticipate playing well this week at the RBC Heritage. He finished in a tie for 9th, but never felt the pressure of contending in the event. For the week, Young ranked 6th in Strokes Gained: Off the Tee and 6th in Strokes Gained: Ball Striking.

Despite being one of the longest players off the tee on the PGA Tour, Young has actually played some really good golf on shorter tracks. He finished T3 at Harbour Town in 2023 and ranks 20th in the field in Good Drive% and 16th in Greens in Regulation in his past 24 rounds. He also has strong finishes at other shorter courses that can take driver out of a players hand such as Copperhead and PGA National.

Young is simply one of the best players on the PGA Tour in 2024, and I strongly believe has what it takes to win a PGA Tour event in the very near future.

Corey Conners +5500 (FanDuel)

Corey Conners has had a disappointing year thus far on the PGA Tour, but absolutely loves Harbour Town.

At last week’s Masters Tournament, the Canadian finished T30 but ranked 20th in the field in Strokes Gained: Approach. In his past 24 rounds, Conners ranks 3rd in the field in Strokes Gained: Approach, 3rd in Greens in Regulation % and 24th in Good Drive %.

In Conners’ last four trips to Harbour Town, his worst finish was T31, last season. He finished T4 in 2021, T12 in 2022 and ranks 8th in Strokes Gained: Total at the course over his past 36 rounds.

Conners hasn’t been contending, but his recent finishes have been encouraging as he has finished in the top-25 in each of his past three starts prior to The Masters, including an impressive T13 at The PLAYERS. His recent improvement in ball striking as well as his suitability for Harbour Town makes Conners a high upside bet this week.

Shane Lowry (+7500) (FanDuel)

When these odds were posted after Lowry was announced in the field, I have to admit I was pretty stunned. Despite not offering much win equity on the PGA Tour over the last handful of years, Shane Lowry is still a top caliber player who has the ability to rise to the top of a signature event.

Lowry struggled to score at The Masters last week, but he actually hit the ball really well. The Irishman ranked 1st for Strokes Gained: Approach on the week and 7th in Strokes Gained: Ball Striking. As usual, it was the putter that let him down, as he ranked 60th in the field in Strokes Gained: Putting.

Harbour Town is most definitely one of Lowry’s favorite courses on the PGA Tour. In his six starts there, he’s finished in the top 10 three times, including third twice. Lowry is sensational at Pete Dye designs and ranks 7th in Strokes Gained: Total in his past 36 rounds on Dye tracks.

Lowry is perfect for Harbour Town. In his past 24 rounds, he ranks 5th in Strokes Gained: Approach, 2nd in Good Drive% and 5th in Green in Regulation %. If he figures it out on the greens, Shane could have his first win in America since 2015.

Lucas Glover +12000 (FanDuel)

This is one of my weekly “bet the number” plays as I strongly believe the odds are just too long for a player of Glover’s caliber. The odds have been too long on Glover for a few weeks now, but this is the first event that I can get behind the veteran being able to actually contend at.

Glover is quietly playing good golf and returning to the form he had after the understandable regression after his two massive victories at the end of 2023. He finished T20 at The Masters, which was his best ever finish at Augusta National. For the week, Lucas ranked 18th for Strokes Gained: Approach and 20th in Strokes Gained: Ball Striking.

Over his past 24 rounds, Glover ranks 9th in Strokes Gained: Approach and 13th in Good Drive %. Harbour Town is a short course that the 44-year-old will be able to keep up with the top players on Tour off the tee. He’s played the course more than 20 times, with mixed results. His best finishes at Harbour Town include a T7 in 2008, but recently has a finish of T21 in 2020.

Glover has proven he can contend with the stars of the Tour on any given week, and this number is flat out disrespectful.

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