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

Your Reaction?

LIKE3
LEGIT0
WOW1
LOL0
IDHT0
FLOP0
OB0
SHANK1

19th Hole

Vincenzi’s LIV Golf Singapore betting preview: Course specialist ready to thrive once again

Published

5 days ago

Apr 30, 2024

Matt Vincenzi

After another strong showing in Australia, LIV Golf will head to Sentosa Golf Club in Singapore looking to build off of what was undoubtedly their best event to date.

Sentosa Golf Club sits on the southern tip of Singapore and is one of the most beautiful courses in the world. The course is more than just incredible scenically; it was also rated 55th in Golf Digest’s top-100 courses in 2022-2023 and has been consistently regarded as one of the best courses in Asia. Prior to being part of the LIV rotation, the course hosted the Singapore Open every year since 2005.

Sentosa Golf Club is a par 71 measuring 7,406 yards. The course will require precise ball striking and some length off the tee. It’s possible to go low due to the pristine conditions, but there are also plenty of hazards and difficult spots on the course that can bring double bogey into play in a hurry. The Bermudagrass greens are perfectly manicured, and the course has spent millions on the sub-air system to keep the greens rolling fast. I spoke to Asian Tour player, Travis Smyth, who described the greens as “the best [he’s] ever played.”

Davis Love III, who competed in a Singapore Open in 2019, also gushed over the condition of the golf course.

“I love the greens. They are fabulous,” the 21-time PGA Tour winner said.

Love III also spoke about other aspects of the golf course.

“The greens are great; the fairways are perfect. It is a wonderful course, and it’s tricky off the tee.”

“It’s a long golf course, and you get some long iron shots. It takes somebody hitting it great to hit every green even though they are big.”

As Love III said, the course can be difficult off the tee due to the length of the course and the trouble looming around every corner. It will take a terrific ball striking week to win at Sentosa Golf Club.

In his pre-tournament press conference last season, Phil Mickelson echoed many of the same sentiments.

“To play Sentosa effectively, you’re going to have a lot of shots from 160 to 210, a lot of full 6-, 7-, 8-iron shots, and you need to hit those really well and you need to drive the ball well.”

Golfers who excel from tee to green and can dial in their longer irons will have a massive advantage this week.

Stat Leaders at LIV Golf Adelaide:

Fairways Hit

1.) Louis Oosthuizen

2.) Anirban Lahiri

3.) Jon Rahm

4.) Brendan Steele

5.) Cameron Tringale

Greens in Regulation

1.) Brooks Koepka

2.) Brendan Steele

3.) Dean Burmester

4.) Cameron Tringale

5.) Anirban Lahiri

Birdies Made

1.) Brendan Steele

2.) Dean Burmester

3.) Thomas Pieters

4.) Patrick Reed

5.) Carlos Ortiz

LIV Golf Individual Standings:

1.) Joaquin Niemann

2.) Jon Rahm

3.) Dean Burmester

4.) Louis Oosthuizen

5.) Abraham Ancer

LIV Golf Team Standings:

1.) Crushers

2.) Legion XIII

3.) Torque

4.) Stinger GC

5.) Ripper GC

LIV Golf Singapore Picks

Sergio Garcia +3000 (DraftKings)

Sergio Garcia is no stranger to Sentosa Golf Club. The Spaniard won the Singapore Open in 2018 by five strokes and lost in a playoff at LIV Singapore last year to scorching hot Talor Gooch. Looking at the course setup, it’s no surprise that a player like Sergio has played incredible golf here. He’s long off the tee and is one of the better long iron players in the world when he’s in form. Garcia is also statistically a much better putter on Bermudagrass than he is on other putting surfaces. He’s putt extremely well on Sentosa’s incredibly pure green complexes.

This season, Garcia has two runner-up finishes, both of them being playoff losses. Both El Camaleon and Doral are courses he’s had success at in his career. The Spaniard is a player who plays well at his tracks, and Sentosa is one of them. I believe Sergio will get himself in the mix this week. Hopefully the third time is a charm in Singapore.

Paul Casey +3300 (FanDuel)

Paul Casey is in the midst of one of his best seasons in the five years or so. The results recently have been up and down, but he’s shown that when he’s on a golf course that suits his game, he’s amongst the contenders.

This season, Casey has finishes of T5 (LIV Las Vegas), T2 (LIV Hong Kong), and a 6th at the Singapore Classic on the DP World Tour. At his best, the Englishman is one of the best long iron players in the world, which makes him a strong fit for Sentosa. Despite being in poor form last season, he was able to fire a Sunday 63, which shows he can low here at the course.

It’s been three years since Casey has won a tournament (Omega Dubai Desert Classic in 2021), but he’s been one of the top players on LIV this season and I think he can get it done at some point this season.

Mito Pereira +5000 (Bet365)

Since Mito Pereira’s unfortunate demise at the 2022 PGA Championship, he’s been extremely inconsistent. However, over the past few months, the Chilean has played well on the International Series as well as his most recent LIV start. Mito finished 8th at LIV Adelaide, which was his best LIV finish this season.

Last year, Pereira finished 5th at LIV Singapore, shooting fantastic rounds of 67-66-66. It makes sense why Mito would like Sentosa, as preeminent ball strikers tend to rise to the challenge of the golf course. He’s a great long iron player who is long and straight off the tee.

Mito has some experience playing in Asia and is one of the most talented players on LIV who’s yet to get in the winner’s circle. I have questions about whether or not he can come through once in contention, but if he gets there, I’m happy to roll the dice.

Andy Ogletree +15000 (DraftKings)

Andy Ogletree is a player I expected to have a strong 2024 but struggled early in his first full season on LIV. After failing to crack the top-25 in any LIV event this year, the former U.S. Amateur champion finally figured things out, finished in a tie for 3rd at LIV Adelaide.

Ogletree should be incredible comfortable playing in Singapore. He won the International Series Qatar last year and finished T3 at the International Series Singapore. The 26-year-old was arguably the best player on the Asian Tour in 2023 and has been fantastic in the continent over the past 18 months.

If Ogletree has indeed found form, he looks to be an amazing value at triple-digit odds.

Your Reaction?

LIKE3
LEGIT3
WOW1
LOL2
IDHT0
FLOP2
OB0
SHANK0

Opinion & Analysis

Ryan: Lessons from the worst golf instructor in America

Published

5 days ago

Apr 30, 2024

Brendan Ryan

In Tampa, there is a golf course that boasts carts that do not work, a water range, and a group of players none of which have any chance to break 80. The course is overseen by a staff of crusty men who have succeeded at nothing in life but ending up at the worst-run course in America. However, this place is no failure. With several other local courses going out of business — and boasting outstanding greens — the place is booked full.

While I came for the great greens, I stayed to watch our resident instructor; a poor-tempered, method teacher who caters to the hopeless. At first, it was simply hilarious. However, after months of listening and watching, something clicked. I realized I had a front-row seat to the worst golf instructor in America.

Here are some of my key takeaways.

Method Teacher

It is widely accepted that there are three types of golf instructors: system teachers, non-system teachers, and method teachers. Method teachers prescribe the same antidote for each student based on a preamble which teachers can learn in a couple day certification.

Method teaching allows anyone to be certified. This process caters to the lowest caliber instructor, creating the illusion of competency. This empowers these underqualified instructors with the moniker of “certified” to prey on the innocent and uninformed.

The Cult of Stack and Jilt

The Stack and Tilt website proudly boasts, “A golfer swings his hands inward in the backswing as opposed to straight back to 1) create power, similar to a field goal kicker moving his leg in an arc and 2) to promote a swing that is in-to-out, which produces a draw (and eliminates a slice).”

Now, let me tell you something, there is this law of the universe which says “energy can either be created or destroyed,” so either these guys are defying physics or they have no idea what they are taking about. Further, the idea that the first move of the backswing determines impact is conjecture with a splash of utter fantasy.

These are the pontifications of a method — a set of prescriptions applied to everyone with the hope of some success through the placebo effect. It is one thing for a naive student to believe, for a golf instructor to drink and then dispel this Kool-Aid is malpractice.

Fooled by Randomness

In flipping a coin, or even a March Madness bet, there is a 50-50 chance of success. In golf, especially for new players, results are asymmetric. Simply put: Anything can happen. The problem is that when bad instructors work with high handicappers, each and every shot gets its own diagnosis and prescription. Soon the student is overwhelmed.

Now here’s the sinister thing: The overwhelming information is by design. In this case, the coach is not trying to make you better, they are trying to make you reliant on them for information. A quasi Stockholm syndrome of codependency.

Practice

One of the most important scientists of the 20th century was Ivan Pavlov. As you might recall, he found that animals, including humans, could be conditioned into biological responses. In golf, the idea of practice has made millions of hackers salivate that they are one lesson or practice session from “the secret.”

Sunk Cost

The idea for the worst golf instructor is to create control and dependency so that clients ignore the sunk cost of not getting better. Instead, they are held hostage by the idea that they are one lesson or tip away from unlocking their potential.

Cliches

Cliches have the effect of terminating thoughts. However, they are the weapon of choice for this instructor. Add some hyperbole and students actually get no information. As a result, these players couldn’t play golf. When they did, they had no real scheme. With no idea what they are doing, they would descend into a spiral of no idea what to do, bad results, lower confidence, and running back to the lesson tee from more cliches.

The fact is that poor instruction is about conditioning players to become reliant members of your cult. To take away autonomy. To use practice as a form of control. To sell more golf lessons not by making people better but through the guise that without the teacher, the student can never reach their full potential. All under the umbrella of being “certified” (in a 2-day course!) and a melee of cliches.

This of course is not just happening at my muni but is a systemic problem around the country and around the world, the consequences of which are giving people a great reason to stop playing golf. But hey, at least it’s selling a lot of golf balls…

Your Reaction?

LIKE17
LEGIT2
WOW0
LOL4
IDHT1
FLOP4
OB1
SHANK23

19th Hole

Vincenzi’s 2024 Zurich Classic of New Orleans betting preview

Published

2 weeks 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.

Your Reaction?