Last fall, my father-in-law joined the more than 650,000 total knee replacement patients of 2013. 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, 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?
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).
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.
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.
 Knee Replacement Statistics: http://www.healthline.com/health/total-knee-replacement-surgery/statistics-infographic
 Arthritis Related Statistics CDC: http://www.cdc.gov/arthritis/data_statistics/arthritis_related_stats.htm
The Wedge Guy: What you CAN learn from tour pros
I have frequently noted how the game the PGA Tour players play is, in most ways, a whole different game than we “mere mortal” recreational golfers play. They hit their drivers miles it seems. Their short games are borderline miraculous. And they get to play from perfect bunkers and putt on perfect greens every single week. And it lets them beat most courses into submission with scores of 20-plus under par.
The rest of us do not have their strength, of course, nor do we have the time to develop short game skills even close to theirs. And our greens are not the perfect surfaces they enjoy, nor do we have caddies, green-reading books, etc. So, we battle mightily to shoot our best scores, whether that be in the 70s, 90s, or higher.
There is no question that most PGA Tour players are high-level athletes, who train daily for both body strength and flexibility, as well as the specific skills to make a golf ball do what they intend it to. But even with all that, it is amazing how bad they can hit it sometimes and how mediocre (for them) the majority of their shots really are — or at least they were this week.
Watching the Wells Fargo event this weekend, you could really see how their games are – relatively speaking – very much like ours on a week-to-week basis.
What really stood out for me as I watched some of this event was so few shots that were awe-inspiring and so many that were really terrible. Rory even put his win in jeopardy with a horrible drive on the 18th, but a very smart decision and a functional recovery saved him. (The advantage of being able to muscle an 8-iron 195 yards out of deep rough and a tough lie is not to be slighted).
Of course, every one of these guys knocks the flag down with approach shots occasionally, if not frequently, but on a longer and tougher golf course, relative mediocrity was good enough to win.
If we can set these guys’ power differences aside, I think we all can learn from watching and seeing that even these players hit “big uglies” with amazing frequency. And that the “meat” of their tee-to-green games is keeping it in play when they face the occasional really tough golf course like Quail Hollow. Do you realize less than 20 of the best players in the world beat par for those 72 holes?
It has long been said that golf is a game of misses, and the player who “misses best” is likely to be “in the hunt” more often than not, and will win his or her share. That old idiom is as true for those of us trying to break 100 or 90 or 80 as it is for the guys trying to win on the PGA Tour each week.
Our “big numbers” happen for the same reasons as theirs do – a simply terrible shot or two at the wrong time. But because we do not have anywhere near their short game and recovery skills, we just do not “get away with” our big misses as frequently as they do.
So, what can you take away from that observation? I suggest this.
Play within your own reliable strength profile and skill set. Play for your average or typical shot, not your very best, whether that is a drive, approach shot, or short game recovery. And don’t expect a great shot to follow a bad one.
If, no, when you hit the “big miss,” accept that this hole can get away from you and turn into a double or worse, regroup, and stop the bleeding, so you can go on to the next hole.
We can be pretty darn sure Rory McIlroy was not thinking bogey on the 18th tee but changed his objective on the hole once he saw the lie his poor drive had found. It only took a bogey to secure his win, so that became a very acceptable outcome.
There’s a lesson for all of us in that.
Ways to Win: Horses for Courses – Rory McIlroy rides the Rors to another Quail Hollow win
Tell me if you’ve heard this before: Rory McIlroy wins at Quail Hollow. The new father broke his winless streak at a familiar course on Mother’s Day. McIlroy has been pretty vocal about how he is able to feed off the crowd and plays his best golf with an audience. Last week provided a familiar setting in a venue he has won twice before and a strong crowd, giving McIlroy just what he needed to break through and win again. A phenomenal feat given that, not long ago, he seemed completely lost, chasing distance based on Bryson DeChambeau’s unorthodox-but-effective progress. McIlroy is typically a player who separates himself from the field as a premier driver of the golf ball, however this week it was his consistency across all areas that won the tournament.
Using the Strokes Gained Stacked view from V1 Game shows that Rory actually gained the most strokes for the week in putting. Not typically known as a phenomenal putter, something about those Quail Hollow greens speaks to McIlroy where he finished the week third in strokes gained: putting (red above). He also hit his irons fairly well, gaining more than 3.6 strokes for the week on a typical PGA Tour field. Probably the most surprising category for McIlroy was actually driving, where he gained just 1.3 strokes for the week and finished 18th in the field. While McIlroy is typically more accurate with the driver, in this case, he sprayed the ball. Strokes gained: driving takes into account distance, accuracy, and the lie into which you hit the ball. McIlroy’s driving distance was still elite, finishing second in the field and averaging more than 325 yards as measured . However, when he missed, he missed in bad spots. McIlroy drove into recovery situations multiple times, causing lay-ups and punch-outs. He also drove into several bunkers causing difficult mid-range bunker shots. So, while driving distance is a quick way to add strokes gained, you have to avoid poor lies to take advantage and, unfortunately, McIlroy hurt himself there. This was particularly apparent on the 72nd hole where he pull-hooked a 3-wood into the hazard and almost cost himself the tournament.
It’s rare that a player wins a tour event without a truly standout category, but McIlroy won this week by being proficient in each category with a consistent performance. From a strokes gained perspective, he leaned on his putting, but even then, he had four three-putts on the week and left some room for improvement. He gained strokes from most distances but struggled on the long ones and from 16-20 feet. Overall, we saw good progress for McIlroy to putt as well as he did on the week.
McIlroy also had a good week with his irons, routinely giving himself opportunities to convert birdies where he tied for seventh-most in the field. When he did miss with his irons, he tended to miss short from most distances. His proximity to the hole was quite good, averaging below 30 feet from most distance buckets. That is surely a recipe to win.
When you add it all up, McIlroy showed little weakness last week. He was proficient in each category and relied on solid decision-making and routine pars while others made mistakes on the weekend. Sometimes, there is no need to be flashy, even for the best in the world. It was good to see McIlroy rejoin the winner’s circle and hopefully pull himself out from what has been a bit of a slump. Golf is better when McIlroy is winning.
If you want to build a consistent game like Rors, V1 Game can help you understand your weaknesses and get started on a journey to better golf. Download in the app store for free today.
Club Junkie: Fujikura MC Putter shaft review and cheap Amazon grips!
Fujikura’s new MC Putter shafts are PACKED with technology that you wouldn’t expect in a putter shaft. Graphite, metal, and rubber are fused together for an extremely consistent and great feeling putter shaft. Three models to fit any putter stroke out there!
Grips are in short supply right now, and there are some very cheap options on Amazon. I bought some with Prime delivery, and they aren’t as good as you would think.
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