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

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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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19th Hole

Vincenzi’s 2024 Zurich Classic of New Orleans betting preview

Published

2 days ago

Apr 22, 2024

Matt Vincenzi

The PGA TOUR heads to New Orleans to play the 2023 Zurich Classic of New Orleans. In a welcome change from the usual stroke play, the Zurich Classic is a team event. On Thursday and Saturday, the teams play best ball, and on Friday and Sunday the teams play alternate shot.

TPC Louisiana is a par 72 that measures 7,425 yards. The course features some short par 4s and plenty of water and bunkers, which makes for a lot of exciting risk/reward scenarios for competitors. Pete Dye designed the course in 2004 specifically for the Zurich Classic, although the event didn’t make its debut until 2007 because of Hurricane Katrina.

Coming off of the Masters and a signature event in consecutive weeks, the field this week is a step down, and understandably so. Many of the world’s top players will be using this time to rest after a busy stretch.

However, there are some interesting teams this season with some stars making surprise appearances in the team event. Some notable teams include Patrick Cantlay and Xander Schauffele, Rory McIlroy and Shane Lowry, Collin Morikawa and Kurt Kitayama, Will Zalatoris and Sahith Theegala as well as a few Canadian teams, Nick Taylor and Adam Hadwin and Taylor Pendrith and Corey Conners.

Past Winners at TPC Louisiana

2023: Riley/Hardy (-30)
2022: Cantlay/Schauffele (-29)
2021: Leishman/Smith (-20)
2019: Palmer/Rahm (-26)
2018: Horschel/Piercy (-22)
2017: Blixt/Smith (-27)

2024 Zurich Classic of New Orleans Picks

Tom Hoge/Maverick McNealy +2500 (DraftKings)

Tom Hoge is coming off of a solid T18 finish at the RBC Heritage and finished T13 at last year’s Zurich Classic alongside Harris English.

This season, Hoge is having one of his best years on Tour in terms of Strokes Gained: Approach. In his last 24 rounds, the only player to top him on the category is Scottie Scheffler. Hoge has been solid on Pete Dye designs, ranking 28th in the field over his past 36 rounds.

McNealy is also having a solid season. He’s finished T6 at the Waste Management Phoenix Open and T9 at the PLAYERS Championship. He recently started working with world renowned swing coach, Butch Harmon, and its seemingly paid dividends in 2024.

Keith Mitchell/Joel Dahmen +4000 (DraftKings)

Keith Mitchell is having a fantastic season, finishing in the top-20 of five of his past seven starts on Tour. Most recently, Mitchell finished T14 at the Valero Texas Open and gained a whopping 6.0 strokes off the tee. He finished 6th at last year’s Zurich Classic.

Joel Dahmen is having a resurgent year and has been dialed in with his irons. He also has a T11 finish at the PLAYERS Championship at TPC Sawgrass which is another Pete Dye track. With Mitchell’s length and Dahmen’s ability to put it close with his short irons, the Mitchell/Dahmen combination will be dangerous this week.

Taylor Moore/Matt NeSmith +6500 (DraftKings)

Taylor Moore has quickly developed into one of the more consistent players on Tour. He’s finished in the top-20 in three of his past four starts, including a very impressive showing at The Masters, finishing T20. He’s also finished T4 at this event in consecutive seasons alongside Matt NeSmith.

NeSmith isn’t having a great 2024, but has seemed to elevate his game in this format. He finished T26 at Pete Dye’s TPC Sawgrass, which gives the 30-year-old something to build off of. NeSmith is also a great putter on Bermudagrass, which could help elevate Moore’s ball striking prowess.

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19th Hole

Vincenzi’s 2024 LIV Adelaide betting preview: Cam Smith ready for big week down under

Published

2 days ago

Apr 22, 2024

Matt Vincenzi

After having four of the top twelve players on the leaderboard at The Masters, LIV Golf is set for their fifth event of the season: LIV Adelaide.

For both LIV fans and golf fans in Australia, LIV Adelaide is one of the most anticipated events of the year. With 35,000 people expected to attend each day of the tournament, the Grange Golf Club will be crawling with fans who are passionate about the sport of golf. The 12th hole, better known as “the watering hole”, is sure to have the rowdiest of the fans cheering after a long day of drinking some Leishman Lager.

The Grange Golf Club is a par-72 that measures 6,946 yards. The course features minimal resistance, as golfers went extremely low last season. In 2023, Talor Gooch shot consecutive rounds of 62 on Thursday and Friday, giving himself a gigantic cushion heading into championship Sunday. Things got tight for a while, but in the end, the Oklahoma State product was able to hold off The Crushers’ Anirban Lahiri for a three-shot victory.

The Four Aces won the team competition with the Range Goats finishing second.

*All Images Courtesy of LIV Golf*

Past Winners at LIV Adelaide

2023: Talor Gooch (-19)

Stat Leaders Through LIV Miami

Green in Regulation

Richard Bland
Jon Rahm
Paul Casey

Fairways Hit

Abraham Ancer
Graeme McDowell
Henrik Stenson

Driving Distance

Bryson DeChambeau
Joaquin Niemann
Dean Burmester

Putting

Cameron Smith
Louis Oosthuizen
Matt Jones

2024 LIV Adelaide Picks

Cameron Smith +1400 (DraftKings)

When I pulled up the odds for LIV Adelaide, I was more than a little surprised to see multiple golfers listed ahead of Cameron Smith on the betting board. A few starts ago, Cam finished runner-up at LIV Hong Kong, which is a golf course that absolutely suits his eye. Augusta National in another course that Smith could roll out of bed and finish in the top-ten at, and he did so two weeks ago at The Masters, finishing T6.

At Augusta, he gained strokes on the field on approach, off the tee (slightly), and of course, around the green and putting. Smith able to get in the mix at a major championship despite coming into the week feeling under the weather tells me that his game is once again rounding into form.

The Grange Golf Club is another course that undoubtedly suits the Australian. Smith is obviously incredibly comfortable playing in front of the Aussie faithful and has won three Australian PGA Championship’s. The course is very short and will allow Smith to play conservative off the tee, mitigating his most glaring weakness. With birdies available all over the golf course, there’s a chance the event turns into a putting contest, and there’s no one on the planet I’d rather have in one of those than Cam Smith.

Louis Oosthuizen +2200 (DraftKings)

Louis Oosthuizen has simply been one of the best players on LIV in the 2024 seas0n. The South African has finished in the top-10 on the LIV leaderboard in three of his five starts, with his best coming in Jeddah, where he finished T2. Perhaps more impressively, Oosthuizen finished T7 at LIV Miami, which took place at Doral’s “Blue Monster”, an absolutely massive golf course. Given that Louis is on the shorter side in terms of distance off the tee, his ability to play well in Miami shows how dialed he is with the irons this season.

In addition to the LIV finishes, Oosthuizen won back-to-back starts on the DP World Tour in December at the Alfred Dunhill Championship and the Mauritus Open. He also finished runner-up at the end of February in the International Series Oman. The 41-year-old has been one of the most consistent performers of 2024, regardless of tour.

For the season, Louis ranks 4th on LIV in birdies made, T9 in fairways hit and first in putting. He ranks 32nd in driving distance, but that won’t be an issue at this short course. Last season, he finished T11 at the event, but was in decent position going into the final round but fell back after shooting 70 while the rest of the field went low. This season, Oosthuizen comes into the event in peak form, and the course should be a perfect fit for his smooth swing and hot putter this week.

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Opinion & Analysis

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

Published

6 days 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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