Opinion & Analysis

Golfers benefit from new knee replacement technology

Published

9 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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19th Hole

Vincenzi’s Sanderson Farms Championship betting preview: Eric Cole ready to show his class in Jackson

Published

1 day ago

Oct 2, 2023

Matt Vincenzi

After a dominant performance by Europe at the Ryder Cup, the PGA TOUR heads to Mississippi for the Sanderson Farms Championship at the Country Club of Jackson.

The course is a 7,461-yard par 72 with fast Bermudagrass greens. The tournament had been an alternate-field event up until the 2019-20 season, when it was upgraded to a standalone event.

The field is largely as expected for a swing-season event, but there are some talented players teeing it up in Jackson this week looking to play their way into next season’s singature events. Some notable golfers in the 156-man field this week include Ludvig Aberg, Eric Cole, Keithy Mitchell and Emiliano Grillo.

Past Winners at Country Club of Jackson

2022: Mackenzie Hughes (-17)
2021: Sam Burns (-22)
2020: Sergio Garcia (-19)
2019: Sebastian Munoz (-18)
2018: Cameron Champ (-21)
2017: Ryan Armour (-19)
2016: Cody Gribble (-20)

Let’s take a look at several key metrics for the Country Club of Jackson to determine which golfers boast top marks in each category over their last 24 rounds.

Strokes Gained: Approach

SG: Approach will be important this week as the club was renovated in 2008 and tried to imitate some classic Donald Ross course features. This means the greens will be relatively small, and finding the right level on approach shots will be crucial.

The course will generate plenty of low scores, so it’s important that players give themselves plenty of birdie looks. Sergio Garcia gained 7.0 strokes on the field in his victory three seasons ago, which was third in the field. Sam Burns gained 8.3 in 2021, which was good for second.

Last season, Mackenzie Hughes gained 5.3 strokes on approach in his victory.

Total strokes gained: Approach in past 24 rounds:

Chez Reavie (+26.8)
Alex Smalley (+23.7)
Sam Ryder (+23.1)
Kevin Streelman (+18.1)
Eric Cole (+17.5)

Strokes Gained: Off the Tee

Placing an emphasis on who the best drivers of the golf ball is a smart strategy. This stat has driving accuracy built into it, and though the fairways are relatively easy to hit at the Country Club of Jackson, long and straight is always a big advantage.

I am looking for golfers who are going to have the shortest approach shots and are coming in from the fairway. In 2020 and 2021, respective winners Sergio Garcia and Sam Burns led the field (+5.5) and (+6.1) in Strokes Gained: Off the Tee. In 2023, Mackenzie Hughes was roughly average off the tee, but that seems to be an outlier when examining the winners in totality.

Total strokes gained: Off the Tee in past 24 rounds:

Brent Grant (+27.0)
Ludvig Aberg (+26.8)
M.J. Daffue (+17.5)
Kevin Yu (+17.1)
Trevor Cone (+16.8)

Driving Distance

With the rough not being a major problem this week, the bomb-and-gauge approach should be very successful.

Driving Distance gained over past 24 rounds:

Peter Kuest (+20.9)
Brandon Matthews (+20.3)
M.J. Daffue (+17.2)
Garrick Higgo (+17.2)
Kyle Westmoreland (+15.1)

Strokes Gained: Par 5

Three of the four par 5s on the course should be reachable by the longer hitters, with the longest par 5 hole measuring 587 yards. Finding eagle and birdie opportunities on the Par 5s this week may be the difference in determining a winner.

Total Strokes Gained: Par 5 in past 24 rounds:

Stephen Thompson (+19.3)
Scott Harrington (+14.1)
Stephan Jaeger (+14.0)
Grayson Murray (+13.8)
Jason Dufner (+12.4)

SG: Putting (Bermudagrass Greens Fast or Lightning)

Historically, SG: Putting at the Sanderson Farms Championship has weighed as the most indicative score of the tournament winner. While this isn’t necessarily rare in PGA TOUR tournaments, it was 10% more important at Country Club of Jackson than the average course on TOUR.

The greens have been either “fast” or “lightning” in every round the tournament has been played. Whoever wins this week will need to catch a hot putter, so the best putters on Bermuda should have the best chance to do that.

Total Strokes Gained: Putting (Bermuda+Fast or Lightning) past 24 rounds:

Martin Trainer (+25.0)
Chad Ramey (+24.3)
Brian Gay (+22.3)
Alex Noren (+19.8)
Ben Taylor (+16.2)

Statistical Model

Below, I’ve reported overall model rankings using a combination of the five key statistical categories previously discussed.

These rankings are comprised of SG: APP (25%) SG: OTT: (25%), Driving Distance (18%), SG: Par 5 (18%), SG: Putting (Bermuda) 14%.

Peter Kuest (+8000)
Stephan Jaeger (+2500)
Kevin Yu (+6500)
Trevor Cone (+20000)
Callum Tarren (+6000)
Chad Ramey (+9000)
Scott Harrington (+30000)
Luke List (+5500)
Matthias Schmid (+10000)
Joseph Bramlett (+20000)

Sanderson Farms Championship Picks

Eric Cole +2000 (DraftKings)

With the PGA Tour’s new fall format, there are a few very talented players that will be looking to parlay a strong fall into an invitation to all of the big money signature events come the beginning of 2024. Eric Cole, who’s looked excellent since his emergence on the PGA Tour, is among the players who has the skill and motivation to challenge for one of the spots up for grabs.

The Florida native is extremely comfortable playing on fast Bermudagrass greens. In the field, he ranks 14th in Strokes Gained: Putting on similar surfaces and has some strong results on Bermuda tracks to back up the statistics. Cole missed the cut at the Country Club of Jackson last year, but he’s a much different player now.

In his most recent start at the Fortinet Championship, Cole finished 4th and gained 12.4 strokes from tee to green, which led the field. In his past 24 rounds, he ranks 5th in the field in Strokes Gained: Approach.

Cole was among the most impressive performers in the fall swing’s first event. Now, he’ll have a much weaker field to grapple with and will benefit from Sahith Theegala, Max Homa and Justin Thomas not being in the field.

S.H. Kim +3300 (BetRivers)

S.H. Kim had one of the most impressive ball striking displays at the first event of the fall series. Kim finished 2nd at the Fortinet Championship and gained 11.0 strokes from tee to green, which was good for second in the field. He also gained 6.0 strokes on approach and 3.2 strokes off the tee.

If his strong performance at Silverado wasn’t enough, he also has an encouraging history at the Country Club of Jackson. Kim finished 13th at the course last season and should be much more comfortable in contention this year with some strong PGA Tour finishes under his belt.

Kim has had two runner-up finishes on the Korn Ferry Tour, both of which came on Bermudagrass greens. If he can build off the best ball striking performance of his career, he will be difficult to beat this week in Mississippi.

Sam Ryder +5000 (BetMGM)

I followed Ryder closely during the Fortinet Championship and he put on a ball striking clinic, which has been the case consistently since July. He finished 14th at Silverado and gained 6.4 strokes on approach, which was good for 2nd in the field. Over his last 24 rounds, Ryder ranks 3rd in Strokes Gained: Approach.

The 33-year-old didn’t have his best putting week in his most recent start (-2.6 strokes), which makes some sense considering the putting splits he’s shown us throughout his career. He typically putts field average on POA greens but he’s statistically a positive putter on Bermudagrass throughout his career. The fast Bermuda greens should be a welcome change for Ryder this week, who grew up playing in Florida.

Ryder’s history at the Country Club of Jackson isn’t spectacular by any means, but he’s yet to play the course when he’s in the type of form he’s in at the moment. If he continues his superb ball striking, he should have a good chance to contend this week in Mississippi.

Ben Griffin +5500 (PointsBet)

Ben Griffin is a player who loves playing on Bermudagrass greens. He has top-5 finishes in his career at the Wyndham Championship and the Butterfield Bermuda Championship. After playing in the final few groups over the weekend, I believe he’ll feel much more confident when he finds himself in that position again.

In his past 24 rounds, Griffin ranks 20th in Strokes Gained: Approach and 15th in Strokes Gained: Putting on fast Bermuda greens. Griffin is one of the better putters on Tour and can get hot in a hurry on the greens. Last year, we saw a shorter hitting good putter win this event, so the bombers can be beaten at the Country Club of Jackson, despite having an advantage.

Griffin played this event last year. He finished 24th in his first trip to the course and gained 6.2 strokes on approach, so the course layout seems to fit his eye. After making the FedEx Cup playoffs last year, the 27-year-old is ready to take the next step in his development on the PGA Tour.

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Opinion & Analysis

The Wedge Guy: 3 surefire ways to never get better at golf

Published

4 days ago

Sep 29, 2023

Terry Koehler

That may seem like a rather strange title for an article, but hear me out.

I’ve written this blog every week for nearly 20 years so that I can share some observations from a lifetime in this game and over 40 years in the golf equipment industry. If you read many of my posts, you know that one of my favorite areas of subject matter is the process of learning how to play this game at a higher and higher level. I can’t begin to number the hundreds of instruction books and articles I’ve digested or the innumerable hours I’ve spent watching golfers of all skill levels.

The simple fact is that the more often you hit your best shots – and the less frequently your worst ones show up – the more enjoyable the game becomes. What amazes me is how many golfers I encounter who must really not want to get better at this game. How else can you explain the fact that, in spite of all the gains in equipment technologies and the unlimited amount of instruction available (much of it free), so many golfers just cannot achieve any measurable semblance of success?

So, a bit tongue in cheek, this week I want to share what I believe are the three surefire ways to never get better at golf.

Ignore the importance of a proper grip

I was taught from the very beginning that the first fundamental of golf is learning how to hold the club properly. Doing so takes no athletic ability whatsoever, and you can practice it to perfection anywhere. I’m a firm believer that there is really only one way to do that, and close observation of elite players on the PGA and LPGA tours seems to verify that.

It doesn’t matter whether you opt for the traditional overlap (Vardon) grip, or the interlock grip, which has become increasingly more popular since the best player of the modern era made it his own. You can even choose the full-finger (not “baseball”) grip on the club, particularly if you are not as strong in the hands (ladies and seniors take note). Your grip can be rotated a bit stronger or weaker, but the fundamentals are the same:

The club has to be controlled with the last three fingers of the upper hand, and the grip needs to be positioned under the heel pad, not across it.
The lower hand pressure is also in the fingers, more specifically the middle two fingers – the thumb and forefinger have to be more lightly engaged, if at all.
The upper or lead hand has to be “in control” of the movement of the club.

Very simply, if you are not holding the club in this fundamentally sound manner, the body and club just cannot move properly through the swing motion.

Disregard the importance of proper posture and setup

Likewise, it requires little to no athletic ability to “just stand there” in the proper posture for the athletic move that is a sound golf swing. And again, watch the best players in the world – there is little-to-no variance from one to the other in the way they position their body to be prepared for a fundamentally sound and powerful, repeating golf swing. I don’t need to describe it – just look at pictures and video of good players – they all start from basically the same posture and set-up. If you think you can become a solid player when you are starting from an unsound, “homemade” set up, you are sadly mistaken. The biggest mistakes I see in this area are that the hands are too high, eliminating the Secret Angle of Success, or that the hands are positioned way too far ahead of the clubhead at address.

Take instruction from your buddies

Golf instruction is part art and part science, and your buddies — even those who seem to be pretty good players — are not likely versed in either facet of golf instruction. But tips and advice are cheap, and I cannot begin to count the number of times I’ve watched or heard a golfer who can’t break 80 (or even 90) try to “coach” someone who also can’t break 80. Unless your buddy has spent hours and years studying the golf swing and can play a pretty good game himself or herself, close your ears and eyes when they offer advice.

Compared to all the costs associated with golf, availing yourself of professional instruction is pretty darn cheap. My Dad had a wise saying: “If it’s worth doing, it’s worth doing well.” And my bet is that you have already committed to the fact that golf is certainly “worth doing.” So, please, engage a professional instructor who “gets” you and see him or her regularly.

So, there you have it. Frank Sinatra made a fortune singing “My Way,” but that certainly isn’t the pathway to better and more consistent golf.

5 examples of how Lexi Thompson has been treated harsher than any of her peers

Published

1 week ago

Sep 25, 2023

Gianni Magliocco

Following Lexi Thompson’s Solheim Cup post-round presser on Friday evening, the 28-year-old has been the topic of much discussion.

Golf pundits and fans alike have been weighing in with their takes after this exchange with a reporter surrounding an untimely shank on Friday afternoon went viral:

Confounding answer from Lexi and subsequent reaction from the US side. It was one of the pivotal moments of the entire day and somehow that's off limits? pic.twitter.com/9std3LFlmN

— Tron Carter (@TronCarterNLU) September 23, 2023

After the incident, LPGA Hall of Famer Nancy Lopez said that Lexi has “been picked on and drug through negative comments. She is tired of it”

So has the criticism of Lexi Thompson been justified, or is this yet another example of her being unfairly treated?

Well, here are five times, in my opinion, that Lexi has been scrutinized far differently over the years than her peers.

2022 KPMG PGA Championship

At the 2022 KPMG PGA Championship, Lexi Thompson held a two-stroke lead with three holes to play. She couldn’t close the deal and lost the tournament.

Afterwards, she was fined $2k (as were the rest of the group) for slow play.

Lexi declined to speak to the media and got hammered on social media for doing so…

Lexi Thompson has declined to speak with the media here at Congressional.

Not a great look?

— Zephyr Melton (@zephyrmelton) June 26, 2022

Almost every golfer at some point has skipped a media session following disappointment on the course, and nobody has really batted an eyelid.

Tiger skipped back-to-back post-round media briefings at the 2019 WGC Mexico after being frustrated with his putting. Remember the backlash over that? Nah, me neither.

Donald Trump

@TheWhiteHouse

Every (or nearly every) big-name golfer under the sun has played golf with Donald Trump. Tiger Woods, Brooks Koepka, Dustin Johnson, Rory McIlroy etc. Nobody really cared.

For whatever reason, when Lexi Thompson did, it was a story, and she took herself off social media soon after the photo was posted.

View this post on Instagram

A post shared by Lexi Thompson (@lexi)

2021 U.S. Women’s Open

In the final round of the 2021 U.S. Women’s Open, Lexi Thompson had a 6-foot eagle on her opening hole. She missed and made birdie to lead by five.

She then lost the tournament.

Following the round, Brandel Chamblee said on ‘Live From’:

“She’s got 6 feet away. Now professional golfers don’t miss the center of the face by a pinhead. Look where she hits this putt on the very 1st hole. Look where this putt comes off the face. She would have missed the center of the putter there by a half an inch. I have never — I have never — seen a professional golfer miss the center of the putter by a wider margin than that. That was at the 1st hole. “

Honest? Absolutely. Correct? Brandel usually is. Has any other LPGA golfer been handed the full-on Chamblee treatment? Not to my knowledge.

2023 Solheim Cup

Lexi Thompson spoke the words, “I don’t need to comment on that” when a reporter asked her about a failed shot, and the golf community collectively lost their minds.

Lost on many people is the fact that she literally answered the question instantly after.

Jessica Korda described the reporting of the awkward exchange with the media member as yet another example of the golf media shredding Lexi, but in reality, it was really just golf media covering the furore created by golf fans reacting to the viral clip.

So sad seeing golf media , yet again, shred Lexi. It’s easy writing about other people’s mistakes. It’s
Golf, bad shots happen- give the girl a break. She grows the game more than anyone on tour… And she’s a great player!!

— Jessica Korda (@Thejessicakorda) September 23, 2023

Lexi then won her next two matches, collecting 3 points from 4 for the U.S. team. But nobody seems to care about that.

Instagram

‘yOu ShoUlD PrAcTIce puTTinG’

There’s very few golfers that have been plagued with such inane posts on their Instagram page as Lexi Thompson has.

I’ve tracked golfer’s social media accounts over the past few years (job requirement, sort of?). I can categorically say that Lexi gets some of the angriest and most aggressive responses to her posts of any golfer. Male or female. (She also gets some very nice ones too).

Despite countless posts of Thompson relentlessly practising her putting, the number of comments from dummies accusing her of neglecting that area of her game is both bizarre and alarming. Notice how the comments have been disabled on the post below? Probably not a coincidence.

View this post on Instagram

A post shared by Lexi Thompson (@lexi)

Go on any other golfer’s social account, and it will be hard to find the same dynamic.

Throw in the scandalous rules decision at the 2017 ANA Inspiration that cost her a second major title and spawned the “Lexi rule,” and it’s hard not to think Lexi has had a bit of a raw deal at times.

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